What's going on in the NHS?

It’s quite difficult for people to get a grip on what is happening in the NHS at the moment. Even the trade unions seem to have gone quiet despite the success of the march on 29th September. At national level the government is slowly realising some of the consequences of the distortions it has created through the Health and Social Care Act and looks like being caught in a trap as the NHS tries to move forward (e.g. by introducing more service availability at weekends etc) but finds itself tangled up in competition law and continuing financial and resource issues. The Conservatives are probably not too displeased at the drip drip exposure of actual or alleged poor practice in parts of the NHS since it softens services up for tendering out once the time is right. This process will be eased by new measures being slipped through such as making it easier for administrators of failing hospitals to insist on changes in neighbouring services (Clause 118 of the Care Bill to be debated in the Commons on Monday 16th Dec), and the looming negotiation on the EU/USA free trade pact. However privatisation is itself in trouble. Serco is abandoning contracts for GP services in Cornwall and hospital services in Braintree and admits that its operations in Suffolk are not producing the profits it had hoped for. Serco now says these services are no longer core to its healthcare strategy. So once again the promises of the private sector have no more value than tinsel. When problems start they just walk away, leaving the public sector and the taxpayer to clear up the mess. Desperate for the NHS not to be too much of an election issue, the Coalition is applying financial sticking plaster over issues such as winter pressures. Meanwhile the rising profile of patient safety has forced some government induced practices (including trying to save money by reducing nursing staff) into reverse. At local level things appear on the surface to be on fairly even keel in Sheffield, though there are major threats to the current configuration of services in Rotherham. There is concern across South Yorkshire that there may be quite a lot of outsourcing going on for smaller services which only people working in the NHS may realise is happening. Also, as hospitals come under pressure to increase the ratio of qualified nursing staff on wards, they may try and compensate by substituting qualified staff in community services by different types of health ‘assistant’ with lower level training. There is real concern about the quality of service such assistants may be able to deliver, not least because their knowledge may not be wide enough to deal with the different issues they may face. Late December and early January will see a series of national and local policy announcements which are likely to spark off further campaigning. The principles for calculating CCG financial allocations from 2015 are expected to be agreed at the NHS England Board meeting next Tuesday, when we will know if the age of local populations will be used as the main weighting for allocation adjustments, rather than measures of deprivation. This will lead to major cuts, especially in the north of England. Sheffield Health and Wellbeing Board have made what they say are vigorous representations and briefed MPs for recent publicity. Allocations for 2014-15 will probably be announced just before Christmas. In January the CCG will consider the future commissioning of musculoskeletal care. Meanwhile local partnership organisations are concentrating on finding ways to improve primary care.