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
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 Act
1991 – Health of the Nation, white paper – the
patient is a customer
1994 – 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, dependable
2000 – The NHS Plan (10yrs) then 2001 Act
2001 – Star ratings
2002 – Reorganisation – District Health
Authorities replaced by Strategic Health
Authorities
2003 – Another reorganisation
2004 – Foundation Trusts created and
another white paper – Choosing Health
2005 – Commissioning a patient led NHS
2006 – Reorganisation and cut in number of
SHAs and Trusts
2006 – 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
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£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
–
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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 ££££
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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 cap
Downbanding
Pensions
On Call
NRRP
Performance pay
Removal of unsocial hours whilst
sick
Spot Salaries
Remove accelerated progression
rd
1/3
cut
Impact on staff
Blamed for being uncaring and cruising
NHS staff survey – 38% work related stress
Low morale
Would not recommend job
Exhaustion – working unpaid overtime – some
average 8 hours / week
Impact on other wellbeing issues
Impact on services & patients
THE SERVICE
Reorganisation
Fragmentation
Record keeping and
continuity
Instability
Financial considerations
put first
Prioritisation
THE PATIENT
Patient choice??
Postcode lottery
Increased risk for patients
Top up payments
Confusion
Emergency 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 Maskell
Head of Health
Unite
@RachaelMaskell
Rachael.Maskell@unitetheunion.org
0203 371 2009