The future of the NHS and social care – for better or worse

As health and care leaders, we believe passionately in the NHS, one of this country’s proudest achievements. Since its creation in 1948, it has constantly adapted to improve care for patients. Today is no different. Staff in health and social care do a superb job treating record numbers, but they are under pressure as our nation’s needs increase rapidly. There are also new opportunities to improve care by making practical changes to the way the NHS works (A&E, cancer and maternity units to close in major NHS overhaul, 19 November).

The good news is that NHS bodies and local councils have come together for the first time across England to develop shared, long-term proposals to improve health and care in the communities they serve, based on collaboration not competition. Their aim is to make real-world improvements for patients: making it easier to see a GP, providing more specialist care in people’s homes, speeding up the diagnosis of cancer and offering help faster to people with mental ill health. The NHS has begun to set out its own stall to meet the challenges of the future. We have a good plan in the Five Year Forward View, and are beginning important conversations with the public about how to make its vision a reality through sustainability and transformation plans (STPs). Now is not the time to go back to the drawing board – instead, we hope that all who value our health and care system will support local leaders getting on with the important task at hand.
Sir Andrew Cash Chief executive, Sheffield Teaching Hospitals, Dr Amanda Doyle Chief clinical Officer, Blackpool CCG, Sir Andrew Morris Chief executive, Frimley Health NHS Foundation Trust, David Pearson Sustainability and transformation plan (STP) lead for Nottinghamshire

The Guardian is right to expose the scandal unfolding regarding plans for the NHS in many areas of the UK . Local campaigners have mounted vociferous opposition to try to protect vital services such as consultant-led maternity and A&E. Many are also promoting Save our Beds campaigns to try to preserve hospital beds in places with poor public transport links. Although people are allowed to speak at local forums, or respond to glossy consultation documents, they wonder whether anyone is really listening to their concerns.

It feels as if there is a hidden agenda and that the lives of those who live in locations with scattered populations and poor infrastructure are not important. It may be the case that Jeremy Hunt and the government are trying to shift the responsibility on to those working at local level, but local people know where the blame lies. Further investment in the NHS is vital: the alternative is unthinkable. The plan to save £22bn by 2020 must be abandoned.
Gillian Telford
Cockermouth, Cumbria

As a former nurse and now a grandmother I completely agree with Cumbrian campaigner Annette Robson (Report, 19 November) that thousands of people, including mothers and babies, will die if further NHS cuts go ahead. The feasibility examination of the policy must have told the government at least some of this. It is no surprise that mothers along with other carers are taking action. We are defending the children we have carried for nine months, given birth to and raised, invested our hearts and minds in, and others in our families and communities. You report that Theresa May told a health chief to ensure hospital closures “did not become a big issue in the newspapers”. But she cannot hide the widespread opposition.
Caroline Barker

Centralised health services impose greater demands upon remaining hospitals. As catchment areas and their populations increase, so do hospital workloads – but there is little present evidence of any hospital having capacity to serve more people. Hospitals are required to have capacities to provide ambulance and A&E services not only to individuals, but sometimes to large numbers of people affected by industrial accidents, large fires, multiple vehicle collisions, bridge and building collapse, storm damage, or by river or sea flooding. And the additional transferred workload of a centralised hospital shutting down, not an unprecedented possibility, is clearly beyond conception.

The proposed centralisation, easy on paper, diminishes essential services of whatever kind and for contingencies of whatever cause, at times when immediate assistance is essential and close by.
James Lewis
Marshfield, South Gloucestershire

When Simon Stevens announced the Five Year Forward View he said it would cost £30bn. He said he could make £22bn savings in this time and needed £8bn more from the government. As the Commons health select committee has shown, the NHS is not getting the £10bn that Jeremy Hunt insisted it was getting over six years and, as the BMA says, savings are to be made using STPs (NHS plans may be cover for cuts, BMA warns, 21 November). Hospitals are in deficit because the tariff has been set too low to cover costs and they cannot control the demand for A&E services, or the flow of patients trapped in hospital because of lack of social care. GPs have had their share of the NHS budget cut and are buckling under the strain – which increases pressure on emergency services.

The chief executive of NHS Providers, Chris Hopson, told the health committee that STPs would not work because there were insufficient funds. Thinktanks such as the King’s Fund and Nuffield Foundation also say that the NHS needs more money. One would hope that a prime minister who promised to fight against “the burning injustice that, if you’re born poor, you will die on average nine years earlier than others” would accept that the NHS and social care need more money. We spend 9.9% of our GDP on health, while France and Germany spend 11%. If we spent another 1% we would have another £20bn each year to spend on health.
Wendy Savage
President, Keep Our NHS Public

So NHS England says that sustainability and transformation plans are to “drive genuine and sustainable transformation in patient experience and health outcomes of the longer term”. What a wonderful double meaning. Our patient experience in North Devon will be transformed alright, but not by a fairy godmother. And the health outcomes will be transformed as, for example, women in labour are forced to travel for anything up to two hours to receive obstetric care.

The government is insulting our intelligence over social care, on which the STP sums depend so heavily, by discharging patients from hospital more rapidly (a main source for its alleged savings). Local government was indeed allowed to increase council tax for 2016-17 by 2% for social care. But that figure did not even cover the cost of the rise in the minimum wage, so was actually another cut, following six years of cuts. Sustainability means underfunding and transformation means cutting services. The NHS is being destabilised – staff will not apply for jobs at a hospital under threat. We need to speak out now.
Ruth Funnell
Save Our Hospital Services

What a shame that Margaret Thatcher didn’t live to see her successors implement her plan to dismantle the NHS (Thatcher pushed for breakup of welfare state despite NHS pledge, 25 November).
Dr Bob Bury

It was deeply disappointing to see the inaccurate reporting on proposals under the Bedfordshire, Luton and Milton Keynes sustainability and transformation plan (Report, 19 November). Our plans to date are all publicly available. Nowhere does it say that any A&E, maternity department or indeed any other hospital service is being closed or moved. We have repeatedly said that no decision about any service has been made, nor will any decision be made without full public involvement and consultation.

Of course none of these messages make for exciting headlines. But it is irresponsible and misleading for the reality – that plans are in their early stages of being developed and that no decisions about any service have been made nor are they a forgone conclusion – to be misrepresented. This is causing unnecessary anxiety for local people and for staff. Our commitment is to providing the best possible health and social care services for our area. We will be working hard to make sure we get clear, consistent information out to local people to ensure they are well informed and can get involved in how health and social care services are designed and delivered.
Pauline Philip
CEO, Luton and Dunstable University hospital, lead for the Bedfordshire, Luton and Milton Keynes STP

There’s nothing new about the inadequate provision of hospital beds in this country. In Miranda Seymour’s book Noble Endeavours, which examines the relations between England and Germany over many centuries, reference is made to the state of hospitals in 1843. “Berlin, with a population of 365,000, offered 3,000 hospital beds. Paris with a population of 1 million offered 20,000. London, with an enormous population of 2 million could supply a mere 5,000 beds.” It seems we are determined to cling to Victorian values.
John Watkins
Blackwood, Caerphilly

I am wondering if there has been any modelling on the ability to staff those hospitals which will take over functions of hospitals being downgraded. It cannot be assumed that nurses in downgraded hospitals will undertake to travel tens of miles each way or relocate nearer to their new jobs. A strong reason to pilot this experiment in one area first.
Dr John Watt
Ormskirk, Lancashire

Dr Griffith’s assertion (Letters, 24 November) that for private companies profit comes before patients is correct. This can be demonstrated in Cambridgeshire where ENT outpatient referrals were awarded to a private company by the clinical group commissioners. Its performance was so dire that in September it had to suspend accepting any new referrals for four weeks because of its failure to deal with waiting lists. Yet in 2015 the company paid out £1m in dividends, director’s fees and profits – money that should have been spent on patient care.
Ian Arnott
Peterborough, Cambridgeshire

A bit rich of Andrew Lansley (Plea for NHS funding, 25 November) to criticise lack of extra funding for NHS in the autumn statement. Remind me, who was it who saddled it with massive spending on needless costly reorganisation?
Chris Baker
Minety, Wiltshire

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