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The government's increasingly desperate attempts to defend their record on the NHS have become less and less credible over the last year. This is partly due to in
creasingly effective local and national campaigns and partly to the crisis in hospitals, primary care and social care has forced more and more of those involved to speak out against the damage being caused by austerity. But many of those who are being damaged have no voice. Poor people, disabled people and the chronically ill have fewer opportunities to make their case as their benefit and treatment rights become eroded. NHS staff are generally gagged in one way or another. Exit can be the only escape leaving the NHS still weaker and now less and less able to recruit staff from overseas.

Large national demonstrations and industrial action by junior doctors, nurses and others have made the strength of feeling around the country quite clear, to the extent that even the Conservatives have got worried enough to promise the outlines of a new financial deal this summer. But will it be too late? Certainly it will be insufficient to undo the damage inflicted since 2010. Meanwhile the stress on services which affect the need for healthcare becomes more and more acute. The unspupported costs of Social Care (which is subject to means tested charges) is driving local authorities to bankruptcy.

Another threat is the developing reorganisation into Integrated Care Systems (previously known as Accountable Care Systems) which threaten to become Accountable Care Organisations. In our local area the Integrated Care System covers Barnsley, Rotherham, Doncaster and Bassetlaw as well as Sheffield. (See posts below.) Increasing pressure from campaig
ners and within the Labour Party is deterring local councils to sign up to these in case they become vehicles for further cuts and privatisation.

Across South Yorkshire resistance is building to the threatened implications of the ICS for local services and South Yorkshire Save Our NHS have formed a political party to stand in the Sheffield City Region Mayoral election on May 3rd 2018. See also Barnsley Save Our NHS.

NHS21END_(Small)NOT KILLED OFF YET. Campaigning does work whether on the streets, in the press or, increasingly in the lawcourts. The government's high-handed tactics are being subjected to an increasing number of judicial reviews. At national level these have forced a public consultation on Accountable Care Organisations starting in May 2018.

Cartoons by Samantha Galbraith @sgalbraith47

For more national information see Health Campaigns Together and Keep Our NHS Public


April 14th 2018 11.45 Regional Demonstration to Save the NHS Leeds

April 25th
Soviet Healthcare via Targets: Are Governments Bringing it into the NHS? Roco 2pm or 7pm

April 28th Sheffield Demonstration against proposed closure of the Minor Injuries and Walk-in Centres (see main website for details)

June 27th The NHS is 70 - but what is its life expectancy? Festival of Debate / SSONHS panel discussion and social. Roco 7pm - 11 pm.

June 30th Health Campaigns Together march for the NHS in London See main wesbite for details.

SSONHS planning and information meetings are generally on the first Monday of the month, except for bank holidays. They are usually at 6pm at the United Reform Church. Chapel Walk/Norfolk St S1

To contact us email


In 2016 abnd 2017 we worked with Sheffield Festival of Debate and other colleagues to promote realistic discussion of the issues facing the NHS. On 4th May 2017 we had a lively meeting debating the future of hospitals and in 2016 we mounted an exhibition on NHS privatisation to coincide with a play, A DUTY OF CARE about Labour and the healthcare market. On 22nd November 2016 we held a panel-led debate on the future of the NHS with local NHS leaders, academics and campaigners. We also held a public meeting on 4th July 2016 to celebrate the NHS anniversary, discuss the STPs, the implications for privatisation in South Yorkshire and North Derbyshire and the consequences of the EU referendum result.

In March 2016 we held a successful workshop Taking Back Our NHS

We supported the Junior Doctors throughout their action because we felt they were being unfairly treated and were being treated as the advance guard for Hunt's uncosted, unfunded and misconceived ambition for a 7 day NHS. (For one of our supporter's views at the beginning of the dispute see this column in the Sheffield Star

For our questions to 2017 General Election candidates and canvassers about the NHS see our
website campaign page

2016 8th-22nd November Exhibition on NHS privatisation How come we didn't know by London photographer Marion Macalpine
Theatre Delicatessen, The Moor

22nd November SSONHS Festival of Debate event
Why is the NHS Under so much pressure? How can we save it for future generations?
Speakers included Dr Tim Moorhead, Chair, Sheffield CCG, Kevan Taylor (Sheffield Health and Social Care Trust) and Professor Sarah Salway (University of Sheffield, Public Health) + local campaigners

Taking Back Our NHS SSONHS workshop

Saturday 12th March 2016, 10am - 2pm


Tuesday 22nd September, 7pm screening of Sell Off, attended by well over 100 people.

Campaigning for GP practices at risk of closure

2nd July Successful SSONHS public meeting addressed by Ray Tallis and speakers from Devonshire Green and Unison.

2nd May SSONHS stall in city centre from 11.30 Come and see us.

The 38 degrees ambulance will also be in Surrey Street at 12pm and conveying the 38 degrees petitions to local Hallam candidates at Wesley Hall in Crookes for 3pm.

25th April - March through Sheffield Hallam, with the People's NHS and 38 degrees

28th February 38 degrees petitioning around Sheffield

22nd November Leafleting in Sheffield City Centre from 12.00 pm in support of the NHS strikers. For A5 and A4 copies of the leaflet which has more information on it see the Campaigns Page at our website

24th November NHS picket lines from 7am to 11am. Rallies at the Hallamshire and Northern General (Herries Road) at 10 am.

We were proud to support the Jarrow to London march for the NHS, organised by Darlington Mums passing through Sheffield on August Bank Holiday Monday. Thanks to everyone for helping and joining in.

24th JULY 2014 Public Meeting jointly with Sheffield Medsin

Is our NHS really in crisis? Behind the headlines and soundbites
Panel discussion led by GPs and health experts from the NHS and universities.

For past activities see our website

Tuesday, 28 April 2015

Is the NHS in crisis? (1) Funding

This is the first in a series of comments on key issues in the NHS. They don't represent an agreed or formal position of SSONHS but are broadly consistent with views across the group's point of view.

Any universal health system will have persistently rising expenditure and this does have to be controlled. However most of the finance figures which are bandied around are constructed to serve either political or vested interests. (see for example here. There is no reason we cannot afford a properly managed universal health service free at the point of access. We currently continue to spend proportionately less than many European countries and in many circumstances (though not all) achieve better outcomes. However a service funded out of general taxation means that there does have to be sufficient general taxation.

For the last two years the successive heads of NHS England have been warning of a funding crisis. The current figure, put out by Simon Stevens in the Five Year Forward View, suggests that on present trends of income and expenditure the NHS will have a funding gap of £30 billion by 2020. He has suggested that this should be met by £22 billion efficiency savings and £8 billion extra from Government. This £8 billion represents a growth figure which Stevens describes as flat real per person (simply taking account of population growth)so is an ambition tailored to Goerge Osborne's targets. However most people seem to agree that the £22 billion efficiency savings cannot be reached - at least not without major cost cutting and privatisation. So flat real per person growth is not enough. However if there were a real term increase of between 2-3%, it has been estimated that the total funding gap could come down to £8 billion. Historically until 2011-12 there was on average a real term annual increase in funding of over 3.7%. The funding nettle has to be grasped. We will get the service we pay for. Apart from the taxes aimed at the wealthy, there is increasing evidence that most people would support small increases in general taxation which were for the NHS.

NB these figures are for the NHS and do not include social care where there has been an overall spending reduction of 13.4% including a 17.4% reduction in spending for older people. (Is it any surprise there is more of a burden on the NHS?)

Talk of a funding crisis is nothing new and was seen by Nye Bevan as one of the essential characteristics of the NHS. His now famous quote about needing to fight for the NHS needs to be linked with things he said even before July 5th 1948, for example: "We shall never have all that we need. Expectations will always exceed capacity."; and "The service must always be changing, growing and improving: it must always appear inadequate." Bevan and Wilson resigned in 1951 when Attlee's Labour government, squeezed by the Korean War, insisted on bringing in charges for spectacles and dentures. The successor Tory Churchill government then introduced prescription charges, using legislation previously set in place by Labour but not implemented. The NHS remained somewhat on the ropes (especially because of issues with GPs) until the Guillebaud report in 1956 showed what good value the NHS provided as a proportion of Gross National Product. Since then in various financial crises even Tory Chancellors have recognised the value of NHS expenditure. Tony Blair vowed to bring health expenditure as a proportion of GDP up to the level of other countries and briefly did so. It has now dropped back.

The current parliament will have had the lowest rate of growth in health spending across the UK since 1955 (0.6%) In 2012 health spending as a share of GDP averaged 9.9% among the EU-15 nations. Only five EU-15 countries spent a lower share of GDP on health (Greece, Italy, Finland, Ireland and Luxembourg). UK GDP has risen by over 9% since 2010. If NHS funding had been maintained at 2010 levels (9.9% of GDP), the NHS budget for the UK could now be over £150bn instead of £113bn. In 2013 Cameron and Hunt were ordered by the head of the UK Statistics Authority to stop saying they had put extra money into the NHS.

This year for the first time in several years the NHS has ended the financial year in deficit - to the tune of about £2 billion. There is general agreement that it it is working at its limit and that staff morale is low. Within the NHS tariff cuts have severely reduced hospital income . Most Trusts which have financial reserves have raided them to break even. Well respected hospital organisations are beginning to panic at the possibility of financial failure. However the definitions of 'failing' Trusts are not moral judgements but are constructed from arbitrary financial rules. Different ways of assessing financial performance would not lead so easily to the risk of major services being offered to private providers.

Some commissioners - both CCGs and NHS England specialist commissioners are also in deficit. By September, especially as winter planning gets under way, the next government will have to find funding to get the NHS through. This may be under guise of a transformation fund to help accelerate changes. Labour has a plan for this, just about, though it is likely to mean more borrowing at least before the projected tax changes kick in. The Tories and Lib Dems have fluttering promises which are being disparaged by financial commentators.

The required changes should include:

1) Abolition of the market. A minimum real estimate of the costs of the market was made a couple of years ago at £4.5billion per year. The actual cost is likely to be much higher. Since the market was introduced, administration costs in the NHS have risen from aroun 6% to 14%. (The US system runs at over 30% admin costs). Not all of this would be saved by market abolition because other mechanisms would also have a cost, but nothing like as much. (NHS Management is generally scapegoated by anyone dissatisfied but poor management, whether by bureaucrats or clinicians, doesn't mean that the NHS does not need management as long as they are managers committed to the service, not beancounters, accountants and marketing people). In some analyses the NHS actually has fewer managers than comparable private sector organisations and charities (though that may depend on the definition of manager). A King's Fund report in 2011 actually suggested that the NHS might be undermanaged (though they too have a vested interest! This should certainly start off with the external marker but should work towards eliminating the internal market as well (introduced under Thatcher).

3) An attack on the PFI agreements which are bankrupting hospitals, sucking money out of the NHS into big service, construction or property organisations. This is covered in the NHS Reinstatement Bill.

3) A revamped approach to human resources, emphasing human, not resources. This will include proper staffing levels, only to be supplemented by expensive agency staff in exceptional circumstances.

4)Productivity improvements (secured through operational changes, not by squeezing staff still further). These could include service integration (done with an emphasis on meeting need, not with cost-cutting as the prime objective; lots of pitfalls here), further identification of wasteful practice (including the advantages of clinicians having regard to the whole person and not just the specialist symptom with which they are presented), the improvement of systems, and, most fundamentally, an unprejudiced look at how hospitals and community health care should be linked up.

5) Better management of demand (see subsequent post) and understanding that if everything else is cut the NHS will be expected to pick up all the resulting problems.

6) A clearer focus on public and community health but, again, understanding how it should link with curative health care. If the NHS is going to put out all sorts of messages about early recognition of symptoms etc, it has to recognise the demand this will generate. Conversely a reduction in public health measures (and lack of consideration of health impact) will lead to more demand for emergency treatments and consequently greater expenditure (as well as trauma for the patient).

Most of these have been somewhere on the agenda since 2010. Lansley's damaging reforms plus the small state mentality of most Tories and the free trade aspirations of many Lib Dems have proved costly distractions (to use a polite word). Regardless of the actual figures, the government must take the blame for the financial chaos they are leaving.