The NHS will share the pain of cuts

Health service staff are not immune to cuts and patients could suffer, the nursing leader tells Denis Campbell.

Despite the cabinet finalising colossal spending cuts across government, the axe will not fall on health. David Cameron has decided that even in an age of austerity the NHS is different, special – too important to the public to endure its share of the pain.



Luckily for Andrew Lansley, the health secretary, his budget is not just immune, it is going to rise in real terms, albeit modestly, each year of this parliament. And the NHS frontline – the sacred, untouchable cow of British politics – won't be hit. Or will it?

Dr Peter Carter knows the NHS inside out. The psychiatric nurse turned chief executive of a mental health trust, and now leader of Britain's 400,000 nurses, has heard Lansley's assurances that the frontline will be exempt. But he's not convinced. "I believe Andrew Lansley when he says he genuinely wants to protect the frontline. But no, the frontline's not immune and the evidence shows that", says the general secretary and chief executive of the Royal College of Nursing (RCN). "A significant number of employers – primary care trusts (PCTs), strategic health authorities or hospital trusts – are cutting services and are cutting posts."

To prove his point he starts reading from an RCN-compiled list of cuts – to staff numbers, or services, or both – that NHS organisations across England have already announced. For example, 600 posts are to go at the Barking, Havering and Redbridge university hospitals NHS trust in Essex, 470 at the Heatherwood and Wexham Park hospitals NHS foundation trust in Berkshire and 300 at the Northumberland, Tyne and Wear NHS foundation trust. The Avondale Unit in Preston is closing two adult mental health wards, the Hawthorn day hospital in Harrogate – which provides short-term intervention for people in psychiatric crisis – has been temporarily closed, and NHS Stockport is decommissioning three services, which will affect 46 members of staff. It is a depressing dossier, reflecting the NHS in England's need to save £15bn-£20bn by 2013-14

Money to leave

"Anyone who says the frontline is being protected is misinformed," says Carter. "At Alder Hey children's hospital in Liverpool nurses are being given packages to leave, in order to save money, and they are not being replaced. Some of our members there are saying, 'I've been offered a good financial package to go; I'm going to take the dosh and get a job somewhere else nearby.' We don't think that Alder Hey is overstaffed and fail to see how they can lose staff, especially when children's health needs are growing. How can that be justified?"

To underline the points, he relates a recent meeting with breast cancer campaigners. "They said their breastcare nurses are being forced to give up working one-on-one with patients who have had the disease and maybe a mastectomy and instead go back to work on hospital wards, for example, for three days of the week," explains Carter. "The nurses don't like it, because they've done all their specialist training, and the patients don't like it, because they are losing a service."

The RCN has an ongoing campaign, called Frontline First, in which nurses alert the union when an NHS trust finalises plans for reductions.

"Nottingham University hospitals NHS trust say they have to save £29m this year and £35m in 2011-2012 and plan to reduce 400 posts by the end of 2011. To do that and carry on with the same level of service must mean that they have been a profligate and wasteful organisation, which is very unlikely," adds Carter. "Our fear is that less people are being asked to do more, so staff will have to work harder, burnout will go up and, unless the trust can demonstrate to the contrary, quality will go down. That could mean staff spending less time with patients, so having less time to feed them, help them mobilise, change their dressing or help them go to the toilet, and also just listening to patients, which is very important. The more you squeeze, the more these things get compromised," he says.

Carter's words and the RCN's evidence-gathering pose an implicit challenge to Lansley, and could eventually become a key political issue. If patient services are cut back, patients will notice. Four years ago, when the NHS last faced a budgetary squeeze, Carter was chief executive of the Central and North West London mental health NHS trust, in charge of a £180m budget. Carter also has a master's degree in business administration. So he knows about budgets. Worryingly, he says the next few years will be far tougher than 2006. "In 2006 the crisis involved a few hundred million pounds. At that time 23,000 posts were lost and that felt difficult. This is a totally different dimension. You're talking about taking £15bn-£20bn out in efficiency savings over the next four years, so compared to the Patricia Hewitt years, this is big stuff. Things are very difficult."

Difficult, too, for Lansley, who has said that the sick will not have to pay for the debt crisis and that the vulnerable will be protected in the taxing times ahead. Those pledges are likely to be tested, as Carter fears that services for older people, mental health patients and those with learning disabilities will be among the first to be hit. The RCN boss also pinpoints the fact that many cuts are happening by stealth, with details hard to extract from the PCTs or hospitals involved. While such organisations may prefer to lose staff as they retire or leave for various reasons, rather than hand nurses and other healthcare professionals redundancy notices, the end result is the same: patients lose, he says.

Carter identifies other areas of the NHS where savings should first be made. He cites the Connecting for Health IT programme – its cost is £12.8bn and counting – and the huge amounts spent on management consultants. Plus, he adds, "waste is rife in the NHS", mentioning over-ordering of medication and electrical equipment needlessly left on all day. And he passionately endorses Lansley's drive to cut 45% of NHS management costs by making non-clinical posts redundant.

Unhappy with cuts

Carter sounds unhappy about the need for the £15bn-£20bn of cuts, but refuses several invitations to say if the target should be relaxed or scrapped altogether in order to safeguard patient care. What he wants, he says, is for everyone involved in the debate about the NHS to be honest that this scale of "efficiency savings" will inevitably mean the loss of some services and hard-pressed staff having to do even more, with the risks – to quality of care and even potentially to safety – that entails.

"The reality is that while at the centre [Whitehall] people have these good intentions, and genuinely want to protect the frontline, some hospital trusts and PCTs are adopting a slash-and-burn, ill thought-through way of doing things," he says.

Lansley will next week address the Tory faithful in Birmingham, and make much of his plans to radically reshape the NHS. Carter, no apologist for the last Labour government, nonetheless notes the big improvements made in the NHS in their 13 years in power. When they came to power in 1997, some patients were having to wait two or three years for treatment – unthinkable now, he acknowledges.

But the danger, warns Carter, is that budget cuts affect real people's lives. So waiting times will start to creep up again because there are too few staff. He says: "Some pockets of the NHS are very inefficient, I know. But the NHS isn't so inefficient that you could take £15bn-£20bn out without affecting capacity or quality."

Lansley has been warned.