• More deep cuts loom as Devon’s NHS must save over £400m by 2024

    9th March 2020 | News | Claire
  • Devon’s NHS continues to be in a financially precarious position and must make more significant cuts to operations, in order to break even by 2024.

    Over £400m must be slashed from Devon’s NHS by 2024, from an annual budget of £2.6bn.

    That’s the main message from a report that will be examined by members of Devon County Council’s Health and Adult Care Scrutiny Committee, next Thursday (12 March).

    Devon’s NHS has been in a financial hole for many years, described as being in the top three most financially challenged health areas in the country, for much of the last decade.

    But matters appear to have deteriorated and it seems that NHS England may now consider our local NHS to be in the top two most financially challenged health areas in the country.

    From April, Devon’s NHS is under orders to save over £100m by next March, after which there must be a programme of swingeing cuts until at least 2024, overseen by NHS England.

    Sustainability and transformation plans were set up some years ago all over the country to implement the government cuts agenda, which forced NHS organisations to make savings to the tune of £30bn nationally.  This is the latest iteration.

    The scrutiny challenge

    I have tried my hardest to try and keep track of these local savings via my role on the Health and Adult Care Scrutiny Committee, but the reality is that the NHS can be incredibly opaque – and each time I asked for a paper on these cuts, the committee has been given no more than a cursory report of vague areas where local NHS services were making savings.

    It has been frustrating and quite wrong given the committee’s legal role in examining changes to health services, on behalf of local people.

    I have been aware of private health scrutiny briefings on this issue for a few weeks and emailed committee chair, Sara Randall Johnson in January, asking for a paper to come to the March meeting.

    There was no reply to my email.

    Will Devon’s NHS be open about its response to the financial challenge?

    I attended the most recent private briefing two weeks ago, which was enlightening and concerning.

    After asking Philippa Slinger, chief executive of what is now called Devon Together (previously known as the Success Regime and various others) some questions about the timing and intention relating to forthcoming cuts, I eventually got agreement for this issue to come before our March committee meeting.

    To be fair to Philippa herself, she gave me the impression of being as open as she could be.

    Importantly she was willing to appear before the scrutiny committee as soon as possible.

    It’s unthinkable to me that the Health and Adult Care Scrutiny Committee – as the only legal check on health services in Devon – may not have examined this issue, where it SHOULD be examined, in the public domain, with the debate recorded by webcast, BEFORE the next round of cuts starting next month.

    Waiting times have soared

    Over the past decade nationally and locally, waiting times have soared and more people than ever (who can afford it) are opting to go private for treatment because of long waits.

    From simple treatments such as physiotherapy for a sports injury, right the way through to paying around £13,000 for a hip operation.

    The presentation for Thursday’s meeting states: “In line with savings made in previous years for the system to break even by 2023/24 recurrent savings of between £99m and £108m are required every year.”

    The presentation also states that the main challenges are focused on catering for a growing and largely elderly population in the county.

    The most pressed area of the budget is acute care (such as at the RD&E or Plymouth Hospital for example).

    The presentation refers to the impact of Devon’s NHS being both short of staff and short of cash:

    • 300 people routinely waiting for more than a year for treatment when the target is 18 weeks
    • 12 times as many people waiting over six weeks for key diagnostic tests than should be
    • Eight out of 10 hospital beds are used for emergency purposes
    • Devon’s population is set to grow by 33,000 in the next five years and by 2030 there will be 36.5 per cent more people over 75 years compared to today
    • 25 per cent of children in Devon are overweight or obese and this rises to 33 per cent by the time they leave primary school

    Bed cuts

    The paper states: “If the way beds are used is not changed, the number available for planned, low risk treatment and operations will soon be zero.”

    But over 200 community hospital beds have been closed in the past few years, and hundreds more acute beds in the area.

    Unfortunately, the numbers of paid care workers have still remained a huge problem, leading to significant delayed transfers of care (hospital discharges) from the RD&E Hospital, in particular.

    Senior doctors have been saying for a long time that we simply don’t have enough beds.

    According to the Kings Fund the total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 to 142,000, while the number of patients treated has increased significantly.

    The Fund states that most other advanced health care systems have also reduced bed numbers in recent years. However, the UK currently has fewer acute beds relative to its population than almost any other comparable health system.

    Thursday’s committee paper does not refer to the annual NHS increment which plummeted to around one per cent from around six percent, in 2010.

    This will, of course, had a significant impact on how the NHS is able to deliver care.

    Areas for action

    I had hoped for a bit more detail on how Devon’s NHS were going to manage around £100m of savings in the next financial year but I’m unable to find anything approaching informative detail on this, which makes it quite hard to scrutinise effectively, on behalf of local people.

    However, the presentation outlines the broad areas for action as the following:

    • Transforming out of hospital care and integrating community services
    • Reducing outpatient appointments by 30 per cent
    • Address the challenges of increasing demand of hospital beds
    • Consideration of creation of a major diagnostic centre in Devon
    • Travelling further for planned care, such as a hip operation
    • Widening access to online GP consultations
    • New technology monitoring equipment supporting people to live independently in their own homes
    • Support more people in their home and community and avoid urgent admissions to hospital
    • Improving cancer outcomes
    • Improving mental health services through a ring-fenced investment fund
    • Shorter waits for planned care through protected capacity
    • Reducing health inequalities
    • Setting minimum requirements for community based care to reduce pressure on emergency hospital services

    So Devon’s NHS is being requested to make further cuts at a very difficult time.

    A long-term lack of paid carers are hampering hospital discharges

    The desire to avoid hospital admissions and to get people out of hospital quickly is long-held one but is increasingly hampered by a significant and long-term lack of paid care workers, especially in the Exeter and East Devon area.

    The massive government funding cuts to adult social care has also meant the closure of many care homes and a big reduction in the number of people who are now receiving paid personal care.

    The impact of much of this falls on unpaid carers looking after loved ones.

    There are a raft of recommendations on this in a scrutiny review I chaired which also comes before the Health and Adult Care Scrutiny Committee, this Thursday.

    Public health budget pressures

    As for Mr Hancock’s oft repeated mantra of investing in ‘prevention’, by which he means public health (preventing people from getting ill in the first place), Devon County Council’s Director of Public Health, Dr Virginia Pearson summed it up at January’s budget meeting:

    She said almost none of the budget now goes on prevention. Almost all of it now goes on treatment because of government funding cuts.

    Devon County Council still at risk of not providing enough nursing care or personal care

    Finally, the council’s latest risk register has now been published for Thursday’s meeting. The following risks are among those recorded as ‘high’:

    • Inability to recruit appropriate qualified adult social care professionals
    • The council fails to meet its statutory market sufficiency requirement for nursing care
    • The council fails to meet its statutory market sufficiency requirement for personal care

    I find it very sad that our incredible NHS, which has been the envy of the world, has been brought to this.

    The pressures facing Devon’s NHS are not of the fault of staff. They are as a result of government underfunding, forced cuts and the demographics of age and demand.

    For the government to put Devon’s NHS under the cosh even MORE ruthlessly than in previous years will cause hardship. To those who need services, the most vulnerable and of course the unpaid carers who look after them.

    It’s even more worrying at a time of a predicted coronavirus epidemic.

    I see my role as a member of Devon’s Health and Adult Care Scrutiny Committee, is to ensure as much information reaches the committee to be examined in an open and transparent way, so that local people’s interests are being served as they should be, at least from a scrutiny perspective.

    The committee meeting starts at 2.15pm on Thursday 12 March.

    You can pick up the webcast here – https://devoncc.public-i.tv/core/portal/webcast_interactive/455423

    The agenda papers are available from this link – https://democracy.devon.gov.uk/ieListDocuments.aspx?MId=3467&x=1

    Pic: Addressing NHS anti-cuts campaigners in Exeter a couple of years ago.


    Send this to the prime minister and Matt Hancock and national newspapers

    Thanks. I think probably all STPs/Integrated Care Systems have to continue to make cuts. Your analysis has made me realise the need to do one for my area's Integrated Care System.