undermining the nhs: the impact of the government’s cuts
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Undermining the NHS: the impact of the government’s cuts. Rachael Maskell Head of Health Unite. The NHS. 5 July, 1948 “not only is it available to the whole population freely, but it is intended … to generalise the best health advice and treatment” Aneurin Bevin, 1946. - PowerPoint PPT PresentationTRANSCRIPT
Undermining the NHS:the impact of the government’s cuts
Rachael MaskellHead of Health
Unite
The NHS
5 July, 1948
“not only is it available to the whole population freely, but it is intended … to generalise the best health advice and treatment”
Aneurin Bevin, 1946
Cuts in the NHS to date
1949 – Prescription Charges (in place in 1951)
1974 – Introduction of Regional and Area Health Authorities
1982 – Area Health Authorities abolished and Districts re-organised
1983 – Start of competitive tendering for ancillary services
1989 – White paper – Working for Patients (NHS reforms) – proposes purchaser/provider split in the NHS, GP fundholders and a state-financed internal market. Also an efficiency drive
1990 – Market introduced with new Act1991 – Health of the Nation, white paper –
the patient is a customer1994 – Regional Health Authorities abolished
with reorganisation
1996 – 3 new white papers, Choice and Opportunity, Delivering the future, The NHS: a service with ambitions
1997 – The new NHS: Modern, dependable2000 – The NHS Plan (10yrs) then 2001 Act2001 – Star ratings2002 – Reorganisation – District Health
Authorities replaced by Strategic Health Authorities
2003 – Another reorganisation2004 – Foundation Trusts created and
another white paper – Choosing Health2005 – Commissioning a patient led NHS2006 – Reorganisation and cut in number of
SHAs and Trusts2006 – White paper – Our health, our care,
our say. This was to oversee the expansion of the market in providing services in the NHS
2010 GENERAL ELECTION
Coalition Plans
There will me no top down reorganisation of the NHS
Liberating the NHS?
2010 – White paper (July)
2011 – Health and Social Care Bill (Jan)
‘The Pause’ (Future Forum)
Passage through parliament
Professionals, Patients, Public – against
2012 – The Health and Social Care Act 2012
2013 – Mass reorganisation of the NHS
Some services in meltdown
The new NHS
The Health and Social Care Act
£3bn to reorganise the NHS 175 bodies now expanded to 400 Public health moved to local authorities CSUs not GPs in charge of the system
– Vested interests
Private Patient Income Cap of 49% Any Qualified Provider Fragmentation and constant change Current structures will implode Change in role of Secretary of State
££££ Money ££££
PFI debt Efficiency cuts (savings) Foundation Trust additional savings £20bn Nicholson Challenge, more to come Cost of internal market £20m under last government –
these costs will escalate More demands on the service, with increasing
longevity Collapse of other support services previously supplied
by Local Authorities and charities
The NHS staff
Pay – freeze and capDownbandingPensionsOn CallNRRPPerformance payRemoval of unsocial hours whilst
sickSpot SalariesRemove accelerated progression
1/3rd
cut
Impact on staff
Blamed for being uncaring and cruising
NHS staff survey – 38% work related stressLow moraleWould not recommend job Exhaustion – working unpaid overtime – some
average 8 hours / weekImpact on other wellbeing issues
Impact on services & patients
THE SERVICEReorganisationFragmentationRecord keeping and
continuityInstabilityFinancial considerations
put firstPrioritisation
THE PATIENTPatient choice??Postcode lotteryIncreased risk for patientsTop up paymentsConfusionEmergency care
When you bring this together
Too many conflicting agendas,
too many vested interests, too many people who have control EXCEPT professionals and
patients
At a cross roads
Full insurance-based health system delivered by a range of providers. Postcode lottery and range of entitlements. Assessment on ability to pay
Restore the NHS – publicly provided, publicly delivered, publicly accountable – free at the point of need for all where patients and professionals are at the heart of the service
Change needed for staff
The NHS
When you are sick you need the NHS, now the NHS is sick the NHS needs you
Unite
“The NHS will survive as long as there are folk with the faith to fight for it.”
Bevan
Questions
Rachael MaskellHead of [email protected]@unitetheunion.org0203 371 2009