Opposition politicians and NHS campaigners have expressed alarm after it emerged that health service bosses throughout England are drawing up plans for hospital closures, cutbacks and other radical changes to meet spiralling demand and close gaps in their finances.
An investigation by the Guardian and the campaign group 38 Degrees has revealed that the NHS at local level could be facing a financial shortfall of about £20bn by 2020-21 if no action is taken.
In an attempt to head off the crisis, NHS England has divided the country into 44 “footprint” areas, with each asked to submit a cost-cutting “sustainability and transformation plan” (STP).
The Guardian has seen the detailed plans for north-west London, while 38 Degrees, a crowdfunded campaign group, commissioned the consultancy Incisive Health to collate and analyse proposals from across the rest of England. Also collected are figures showing the projected financial deficits in 2020/21 that will have to be plugged by cost-saving reorganisations.
The shadow health secretary, Diane Abbott, called the report “a damning indictment of this government’s underfunding and mismanagement of the NHS”.
She said: “It reinforces all the concerns highlighted by the recent NHS Providers report and the King’s Fund survey of trusts’ NHS finance directors. Emergency closures of vital units across the country testify to a real crisis.”
There are proposals in the Leicester, Leicestershire and Rutland region to reduce the number of acute hospitals from three to two. In the Black Country region of the West Midlands there is a proposed reduction of the number of acute units from five to four and closure of one of two district general hospitals.
More general plans include reducing the number of face-to-face meetings between doctors and patients in north-west London through the use of more “virtual consultations”, and a proposal to give patients coaching to help them manage their own conditions.
The Liberal Democrat health spokesman, Norman Lamb, said STPs made some sense in principle. He added: “However, it would be scandalous if the government simply hoped to use these plans as an excuse to cut services and starve the NHS of the funding it desperately needs.
“While it is important that the NHS becomes more efficient and sustainable for future generations, redesign of care models will only get us so far – and no experts believe the Conservative doctrine that an extra £8bn funding by 2020 will be anywhere near enough.”
However, Stephen Dalton, chief executive of the NHS Confederation, denied that the changes meant the NHS would “indiscriminately close services”.
He told BBC Radio 4’s Today programme that there had long been a reluctance by political leaders to address the NHS’s cumbersome organisation, and that local discussions were better than having a single plan for the whole country.
But Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, said a “glut” of hospital services could shut down.
He said: “Our members tell us that they are struggling to keep services open because of workforce shortages and they therefore face really difficult decisions about do you close down something either permanently or temporarily because you cannot staff it safely?”
NHS bosses were asking managers to identify “marginal acute services where you are trying to prop up what is really an unsustainable rota”, he said, adding: “So we would expect to see a bit of a glut of those kinds of decisions going forward because our guys have been specifically asked to identify them.”
Some of the proposals are likely to be given the go-ahead as soon as October, though consultation would then have to take place locally.
Last year’s Conservative manifesto pledged an extra £8bn a year for the NHS by the end of this parliament, as demanded by the NHS chief executive, Simon Stevens, in his 2014 “five-year forward view”. But Stevens made clear that was the minimum money needed, and radical reforms to the way healthcare was delivered would also be necessary to ensure the NHS stayed within its budgets.
A spokeswoman for NHS England said the health service needed to make major efficiencies. She said:“We need an NHS ready for the future, with no one falling between the cracks. To do this, local service leaders in every part of England are working together for the first time on shared plans to transform health and care in the communities they serve, and to agree how to spend increasing investment as the NHS expands over the next few years.
“It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.”
North-west London’s draft plan highlights risks to the implementation of the programme, including a failure to shift enough acute care out of hospitals, a possible collapse of the private care home market, and a failure to get people to take responsibility for their own health.
Two local authorities in north-west London, Hammersmith & Fulham and Ealing councils, have refused to sign up to the draft plans because of concerns about hospital closures. Officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.
A spokeswoman for NHS North West London insisted the policies were based on evidence, saying: “There is a whole body of clinical evidence, research and best practice that clinicians are using to deliver better clinical care for patients.”
Alarm at NHS plans for closures and cuts to tackle growing deficit
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