NHS: The Capped Expenditure Hush-Up

Senior NHS officials have refused to reveal savings plans in a brutal cuts programme that could greatly affect patient services. Clinicians fear the dire impact it could have on the service after the doctors’ union the British Medical Association led an investigation into the cuts by NHS Improvement, a body responsible for overseeing NHS trusts.

Cutting costs

Thirteen local health areas have been selected for the Capped Expenditure Process after they failed to meet previous savings targets. The BMA says 44 members of staff from NHS Improvement work on the cuts programme with an annual salary bill of more than £4.5m.

The areas affected include North Central London, North West London and South East London, meaning more than 20% of areas affected by the CEP are in London.

The King`s Fund, a charity and think-tank working to improve healthcare in England, explained how these caps are distributed. “Central bodies argue these areas have been historically overspending their ‘fair share’ of NHS funding and do not have an affordable set of financial plans for 2017-18,” it said. “However, it is unclear what a ‘fair share’ means in this context. Healthwatch groups in two of the CEP areas argue that historical under-funding of clinical commissioning groups in their region has not been adequately accounted for.”

Woe for next generation

A senior consultant from North Central London told the BMA the plan was “dreadful”  and the staff behind  it “haven’t involved clinicians at all. I don’t think many people even know this is going on and probably haven’t heard about it.”

She gave the stark warning that “Doctors went into medicine to look after patients. The worry is you can no longer expect the NHS to look after you safely and certainly the next generation can’t.”

The savings plans were ordered through a letter entitled “Capped Expenditure Process – requirement to produce affordable operating plans by 5 May 2017.” It began on a positive note saying the NHS`s overall financial performance had improved in the last year before pointing a stern finger at areas that are “historically and substantially” overspending. “In effect they have been living off bailouts from other parts of the country,” it said. “This is no longer affordable or desirable. So going into 2017-18 it is critical that those geographies that are significantly out of balance now confront the difficult choices they have to take.”

Plans kept secret?

When the BMA sought copies of the plans NHS Improvement refused, saying in July that the plans it had received were only proposals and not final despite the fact that the deadline for final plans had passed two months earlier. NHS Improvement then refused a Freedom of Information request by the BMA on the grounds that the plans belonged to the individual authorities. The BMA reacted by going directly to the individual authorities to ask for the plans. When the BMA published its findings just eight of the 13 areas had responded and no real insights into the plans were given.

The South East London “sustainability and transformation plan” did however give the reassuring response that there would be no reduction in its beds or clinical workforce, saying the savings could possibly be made in back office administration, although it did admit there could be changes to prescriptions. For the time being this is a work in progress that needs to be watched so that the cost cuts cannot be hidden from public view.

 

by Stewart Vickers

The post NHS: The Capped Expenditure Hush-Up appeared first on Felix Magazine.