The funding crisis that faces George Osborne as he delivers his spending review today is arguably the worst the NHS has ever seen, following five years of an unprecedented funding squeeze imposed across the health service.
At the Royal College of Midwives, we’ve seen the impact on maternity services. Maternity services are overworked, understaffed and struggling to cope, with maternity unit closures, budget and training cuts as well as reduced services among the key issues highlighted in a survey of senior midwives.
The survey of Heads of Midwifery found that over two-fifths of maternity units had to close temporarily in the year ending April 2014 – 32.8 per cent, as well as in the year ending April 2015 – 41.5 per cent, because they couldn’t cope with demand. The RCM say that the number of closures reflects rising demands on services due to increasingly complex births and low staffing levels.
The RCM’s annual overview of the state of maternity services, the State of Maternity Services Report 2015, calculated that in England services are 2,600 midwives short of being able to cope with the number of births.
RCM have said that “a failure to have the right numbers of staff to deliver the safest and best care ultimately leads to greater costs in the long-term.” RCM’s survey found that well over a quarter of HoMs – 29.5 per cent in 2014 and 29.6 per cent in 2015 – reported they did not have enough midwives. As staffing shortages bite, as well inadequate funding, services are also being reduced. A tenth of Midwifery heads reported that they had to reduce services in 2014 – and more than a tenth reported the same this year.
Services cut include fewer specialist midwives, fewer parent classes and less bereavement and breast feeding support. The pressures on existing services led some HoMs to report having to provide additional midwifery services but without any extra budget. The survey also revealed that two-fifths of HoMs had reduced training for staff in the last year – 21.9 per cent in 2014 and 20.3 per cent in 2015.
Some of the comments from senior midwives illustrate the critical nature of the crisis in maternity services:
“Staffing is and will remain a safety issue and financial pressure. The level of pressure everyone is feeling is now palpable. Worrying times.”
“I am very concerned about the state of the NHS. How is it possible to continue providing high levels of individualised quality care year on year with high cost reductions, cuts to training budgets and more women with complex needs? Stress in the workplace directly affects women's care. The pressure all grades of staff are experiencing is palpable.”
“The continued pressure of adding services to the midwives portfolio without extra funding, because the service is apparently in tariff, this is not sustainable.”
So has George Osborne come up with a solution?
Yesterday’s announcement NHS spending over the next five years was typical of the Chancellor. Behind the headline grabbing figures very real risks remain. To be sure, it is welcome that the calls of health unions, campaigners and the medical profession for some form of frontloading over the spending review has been heeded and £3.8bn next year will help alleviate some of the immediate pressure of the financial crisis brought on by five years of an unprecedented funding squeeze imposed over the last five years.
However, changing the ring-fence from the whole health budget to NHS England means that large areas of health spending will be subject to cuts. At the RCM, we are greatly concerned that what the Chancellor is giving with one hand, he is taking away with another. Cutting funding for training bursaries is a ludicrous false economy that will only exacerbate shortages and escalate costs down the line. Saddling nursing and midwifery staff with student debts during a decade of NHS pay restraint is not the way to attract, recruit and retain the new full time staff we need.
And let’s not forget, the NHS as a whole is a long way from being out of the woods. The £8bn funding agreed as part of the NHS Five Year Plan was aimed at plugging the spending gap. If the government is genuine about delivering new models of care and 7 day services across the NHS, then further investment will be needed. We can’t continue to rely on the goodwill of an over-stretched and under-valued workforce providing free over time. Transforming care cannot be done on the cheap.
Neither can we take for granted that the NHS will be able to find the £22bn savings that Simon Stevens has committed to. Three quarters of savings made under the ‘Nicholson Challenge’ of the last five years came on the back of tariff cuts and pay restraint, neither of which are sustainable going forward. This is a huge whole that no-one seems prepared to honestly acknowledge.
This problem will really hit hard in the middle of this parliament, as the spending profile outlined today shows a huge dip in funding following the initial injection of £3.8bn. Increases of just £500m and £900m face the NHS between 2018 and 2020. If the savings have failed to emerge and the health service continues to cope with deficits while struggling to phase in seven day services, those years could be very difficult indeed.
Further cuts to public health will also weaken exactly the kind of local preventative interventions that we need to manage demand on health services over the long run. Combined with the massive cuts expected to local authority budgets, with further impacts on the provision of social care, the ability to manage demand and to deliver the integration between local government and the NHS that is central to the transformation of healthcare is being further undermined.
The TUC-led All Together for the NHS campaign has spent the run up to this week’s Spending Review highlighting the various ways in which the government’s squeeze on NHS funding has impacted on different services. From A&E waiting times, to staff shortages, over-stretched GPs, cancer care and mental health – services are under increasing pressure despite the best efforts of fantastic NHS staff.
This personal view was originally published on OpenDemocracy under a CC-BY-NC licence