The “offer” that the NHS makes to patients will have to change, with greater rationing of services and a diminished ability to provide care for elderly and infirm people in their homes, unless the Government ends five years of reduced funding and pay freezes, the leader of Britain’s doctors has said.
Dr Mark Porter, chair of the Council of the British Medical Association (BMA), accused the Government of being “fundamentally dishonest” by demanding that the health service match ever-increasing demand with flat levels of funding.
Speaking exclusively to The Independent on Sunday before the BMA’s Annual Representative Meeting in Harrogate, Dr Porter said that the NHS was reaching the limit of what it could do with its current resources.
“They [the Government] have to decide one way or the other,” he said. “We either match the increased demand with proper investment in resources, or we decide that the offer changes.”
The health service has already been forced to ration services, with treatment for conditions such as cataracts, back pain and physiotherapy services removed from NHS lists in some areas because of tightening budgets.
But Dr Porter said future rationing could threaten key government and NHS ambitions to vastly improve home care for Britain’s elderly with an “integration” of NHS and social care services.
“Everybody expects the demand for that to increase,” he said. “I would expect, if the boundary [of what the NHS can afford to do] shifts, it will shift more towards leaving people on their own unless they have a demonstrable, actual medical disorder. … The worst outcome will be to prevent the very integration of care we believe is necessary.”
Demand for the political parties to commit to more spending on the NHS is growing, as the service shows signs of strain after five years of government austerity. Patient demand is increasing by an estimated 4 per cent each year.
Highlighting a recent report by the American think-tank the Commonwealth Fund, which showed the NHS remained the most efficient and effective healthcare system in the world, Dr Porter said the health service was weathering the storm, but raised doubts over its ability to continue to perform well if restraints on its budget, which exceeds £100bn, persisted into the next parliament.
Already one in three NHS hospitals run a financial deficit and the NHS in England as a whole is expected to face a deficit of £2bn next year, and £30bn by 2021.
Key waiting-times targets for patients with suspected cancer and GP referrals for specialist treatment have been missed already this year. The number of people visiting A&E has reached record highs and many are having to wait more than the targeted four hours to be seen.
Dr Porter, who works as a consultant anaesthetist at the University Hospitals Coventry and Warwickshire NHS Trust, said the signs of what Labour has termed a “summer crisis” were worrying.
“Winter crises are caused by the increase in demand because of temporary increases in illnesses and accidents,” he said. This crisis is coming a few months into the financial year. It’s reasonable to suppose that’s because this year’s funding targets are tighter than last year’s.”
“Every [NHS] provider is responding differently. … Some will have a recruitment freeze, others will be closing beds – all designed to control costs. The common feature is that you reduce capacity. If you reduce capacity with increasing demand you end up with crisis.”
Jeremy Hunt, the Health Secretary, says the NHS can save yet more money by providing safer care and avoiding litigation costs, while Labour’s Andy Burnham says it must focus more on preventive care in the home, before the taxpayer is asked for more money.
However, Dr Porter warned any future Labour government against another “top-down reorganisation of the NHS”, saying that “prescribing from Whitehall” had left the service in chaos during the coalition’s health reforms, which finally came into effect last year at an estimated cost of £3bn.
Dr Dan Poulter, a Health minister, said: “The NHS is on track to make £20bn savings this parliament to reinvest into front-line care, and we are confident it will continue to make the savings necessary to meet rising demand.
We’ve taken tough decisions to protect the NHS budget, which is allowing us to strengthen family doctoring, reform out of hospital care, and improve GP access for 7.5 million people across the country.
“We are also acting now to integrate health and social care through the £3.8bn Better Care Fund, a radical move towards integration of health and social care.”