BMJ warning over future of NHS

The next five years are likely to be the “most challenging and decisive that the NHS in England has ever faced” with finances already “cut to the bone”, an open letter to the next health secretary has said.

Dr Fiona Godlee, editor-in-chief of the British Medical Journal, and her colleagues have written to whoever takes on the role when the next government is formed, warning that “England’s NHS is stretched close to breaking point”.

They said the health service is “still reeling” from the “costly and distracting” reforms of the coalition Government, while it is also having to cope with virtual flatline funding in real terms since 2010 combined with the growing demands of an ageing population with increasingly complex needs.

“Extreme cuts to social care have exacerbated the pressures, causing knock-on effects across the service,” they wrote.

“Waiting times for treatment are the longest for many years. Staff morale in many parts of the service is at rock bottom because of real terms pay cuts and the relentless workload. Many GPs are retiring early, and new recruits are thin on the ground.”

They added that patient safety is now at risk, with 13 NHS trusts currently in special measures because of concerns about the quality of care being delivered, while the cumulative deficit of hospital trusts and other NHS providers in England reached a record 1 billion last year and is expected to double by the end of 2015/16, with 80% of acute trusts now in the red.

They point out that NHS England chief executive, Simon Stevens, said savings of 22 billion over the next five years are necessary, “but this level of saving will still require efficiency gains never before achieved by the NHS, and a further 8 billion is needed from government by 2020 just to stand still”.

Their letter sets out a number of requests they urge whoever comes into power next month to commit to, starting with ensuring that the NHS remains publicly funded and free at the point of need.

The BMJ journalists also ask for the new health secretary to “focus on collaboration not competition and marketisation”.

“Too much faith has been placed in the internal market as the cure to all of the NHS’s ills. Health is not a commodity; market competition has fragmented the NHS, with the evidence for its effectiveness patchy at best,” the add.

Protecting funding for public health and ring fencing public health budgets for vital services is also requested, along with resisting the temptation to introduce new top-down reorganisation – as former health secretary Andrew Lansley did by introducing the Health and Social Care Act 2012.

The letter said the “NHS needs good transparent governance and less political interference”.

“As Anita Charlesworth of the Health Foundation says, your job is now to provide ’hope and vision’ rather than a shopping list of new policies.”

It points out that the UK spends the joint lowest of any G7 country on healthcare as a proportion of gross domestic product.

“The NHS is not unaffordable, but if it is deprived of the funds it needs to meet demand effectively, it could become so,” they add.

“History will not forgive another health secretary whose actions contribute to its decline.

“Let this be the five years that secure the NHS’s future as the best and fairest health service in the world.”

British Medical Association (BMA) council chair, Dr Mark Porter, said its recent large-scale survey of GPs found that a third are considering retiring from general practice in the next five years.

He said added that this is “at a time when politicians of all parties are trying to outbid each other on the number of new GPs they can magically produce in the next parliament”.

“While staff have done as much as they can to protect and improve patient care, they are battling rising demand and years of underfunding that have left the NHS close to breaking point,” he said.

“This has been compounded by the costly and unnecessary reorganisation that distracted attention from the real issues and wasted millions of public money.

“Doctors on the ground are seeing first-hand how the pressures on the system are affecting the delivery of care across the NHS and the impact this is having on patients.

“If we are to secure the NHS in the next parliament urgent action is needed to address the years of underfunding, the damaging marketisation of the NHS, the increasing recruitment and retention crisis and the health inequalities and major public health issues in our society.”