The state of healthcare in Lancaster: Privatisation, budget cuts, workforce shortages and the county's £805m NHS blackhole

Andrew Bennett is the chief officer for Lancashire North Clinical Commissioning Group (CCG), A GP led organisation which decides where and how local NHS services (including hospital, community and mental health services) should be delivered across our district.

PRIVATISATION

There’s a problem with the word ‘privatisation’ - where a big business takes over a service from the NHS, or when the private sector gets involved.

The use of tendering in the NHS, when the tender awards the service to a private sector organisation - I think that’s been the concern. That process has been going on for about ten years now.

The amount of care that’s provided to the NHS by the private sector is only six per cent, and there’s a fuzziness about what people are objecting to.

We’ve not chosen to do a large amount of tendering here in north Lancashire, we’ve chosen to use what we’ve got here in the area.

We make an annual amount of money available to St John’s Hospice for example, which is not a private company.

Over the last five or six years we’ve had the lowest waiting times for operations, and one of the reasons for that is because private hospitals provide surgical services to the NHS.

However, if you’re a taxpayer, you have every right to question how the NHS spends its money, and I support groups like 38 Degrees who are asking questions.

Recently, Lloyds Pharmacy took over the outpatient pharmacy provision at the Royal Lancaster Infirmary, and as of this week, minor eye problems such as red eye, soreness and visual disturbance will be dealt with by opticians, rather than via a hospital visit.

LANCASHIRE’S £805m NHS BLACK HOLE

Campaign group 38 Degrees has estimated that health trusts across Lancashire have to make £805m of savings by 2020.

This is an estimate of a five year forward view from October 2014.

If the NHS continued with the same rate of financial pressure, coupled with an ageing population, there would be a £30bn gap nationally. What happened then was that the incoming Tory government said we’ll take that seriously, and we’ll offer the NHS £8bn, and the NHS would need to identify £22bn of savings and improvements.

The £805m is Lancashire’s share of the £22bn. The concern is now how we’re going to do that. The challenge is for the NHS and the local government to look at how we’re working together to solve the issues.

We can’t stop people getting older, and we can’t stop the rising number of older people.

The hospitals are talking about how they can work together more efficiently - if they can buy things together to get better deals for example. It should be obvious, one way is to buy things over longer periods of time.

It’s also about people taking the right advice, and having the right tools for self care.

The NHS remains a critical national institution, and we’re having to make the money we get work harder. To some degree it’s about the community taking responsibility for their own health and wellbeing as well, and saying - the person that can care about this best is me. The next five years is going to be crucial.

JUNIOR DOCTORS

There’s continuing industrial action which is of real concern to everyone - patients, staff and the wider community. There is still no proper dialogue between the government and the BMA, which is regrettable.

We hope that they can reach an accommodation so that the strikes are put off.

Obviously our colleagues in the hospitals are having to act quickly to plan for the service impacts of this.

They’ve already had some experience of this. There’s a really critical planning stage now but it will impact on patients if strikes go ahead. Quite a lot of clinical services run seven days a week already. Our community services all run seven days, if we were to change any of those, you would have to make proper plans.

Not every service needs to be delivered seven days a week. The NHS needs to be clear about what services these are. What we’re trying to do is make sure services are accessible at the time they need to be. GP practices in Morecambe have been testing when people want to see a GP. We’ve found that Saturdays are popular, Sundays not so much.

There’s got to be a balance between having a service and having the resources to provide it.

WORKFORCE SHORTAGES

There are some examples of work force shortages impacting on services here.

Again the NHS has got to come up with realistic plans about how many people we need to run services, as at the moment it’s proving difficult to recruit.

We do a lot of work to promote ‘grow your own’ staff, with drives to recruit people from the local area.

It’s about showing people the wide variety of roles within the NHS, a lot of people are looking at jobs that aren’t necessarily clinical.

A&E CRISIS?

The NHS is changing, and it has a lot to do to explain that to people.

In terms of the A&E, we need to try and educate people about the options they have - whether it’s necessary to come to the A&E - we need to help people to make the right decisions.

If there’s a service you can get in Morecambe, or over the telephone, why would you spend money getting a taxi over the river to the RLI for instance?

The press has spent the last year talking about a crisis, and that makes things difficult.

The risk is that people who need to seek treatment might be put off. Older people might think, ‘I don’t want bother the doctor or the hospital’ which is not constructive.

MERGER

Clinical Commissioning Groups (CCGs) were set up in 2013. Our CCG has worked really well with Cumbria, and what we’ve found are a lot of overlaps across the Morecambe Bay footprint.

We think we can be more effective if we have a single team working on Morecambe Bay. It’s more efficient, particularly given the georgraphy. If we get the all clear it would come into effect in April 2017.

We think we can do recruitment a lot better as well.

There will be no more management positions than there are currently.

CCGs have a fixed running cost, which was reduced in 2015 as our management costs went down. We’ve been holding vacancies..

NHS VANGUARD

There are a number of national negotiations over drug prices and our CCG has done a lot of work on reviewing prescribing.

You can get a branded drug for £1, and a generic drug that costs 20p.

We want to help people move to a generic. There’s a lot we can do, but we’re not facing huge financial problems around this.

We’ve got to balance the books, the NHS budget is growing, we’ve actually got more money to spend this year on health in Lancaster and Morecambe.

But what has changed is the rate of increase funding is not running as it was five years ago. We got £5 funding last year, and £5m funding this year. We’ve had a supply of additional funds to move BCT forward and we have to compete for resources.

When we first started out there were 29 vanguards, and now there are 50, so there were elements of funding we applied for that we didn’t get.

We asked for some IT resources, to suppport some of the changes that we wanted to make around clinical services, the workforce, and help us to support all of those processes. We’re considered to be a very positive pilot community.

There are a number of projects we would expect to bid for next year - including children’s services, technology, Skype meetings with doctors, rheumatology and mental health.

In terms of the remote meetings with doctors, you can be sitting in the RLI talking to a specialist in Barrow.

It’s a hi definition camera and the feedback we’ve had is positive, but it’s early days.

One of the good things about being a vanguard is that we can try out these things.