Budget Statement

Baroness Meacher Excerpts

Thursday 27th March 2014 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I rise to address a widespread concern about a single sector of our economy, the NHS, and to pursue the statement from the chair of the Royal College of General Practitioners, Dr Maureen Baker, who described the Chancellor’s Budget as,

“yet another blow for patients and for general practice”.

I should declare my interest in the NHS.

General practice provides about 90% of all NHS patient contacts and yet its funding now stands at an all-time low of 8.39% of the NHS budget. People justify the squeeze on GPs because they had a good pay rise in the 2004 contract. We need to remember why that increase occurred. At the time there was a recruitment crisis in general practice and GPs’ incomes had fallen behind those of comparable professional groups. This was a catch-up settlement. Since then GPs’ pay has fallen by 11% in the four years 2008 to 2012, and we are now back in the situation we had in 2004—a recruitment and retention crisis. Advertisements for GPs which five years ago would have generated 40 to 50 responses now generate none or possibly one. Young doctors who would have become GPs four or five years ago are now looking for jobs abroad. Indeed, they are looking for careers abroad; they are not going to come back. At the other end of their careers many GPs are retiring—far too many—at the age of 50. The inevitable results are delayed hospital admissions and more expensive and prolonged hospital treatments due to delayed interventions. These unnecessary hospital expenditures absorb excessive funds and lead to further cuts to primary care, and so the downward spiral continues.

A recent King’s Fund report points to the growing consensus that if we are ever to sort out the demands of an increasing and ageing population at a time of financial constraint, the NHS must deliver services closer to people’s homes and focus more on prevention rather than simply treating people in hospital down the line. The funding crisis is undermining this objective and indeed threatening the capacity of the NHS as a whole to meet the challenges ahead.

Some may argue that this is a matter for the Department of Health and the distribution of funds within the NHS. That is only partly true. My concern is that the overall funding of the NHS is the problem. The demand for the NHS to find £20 billion of so-called productivity improvements by 2015 has, in fact, led to swingeing cuts alongside efficiency savings.

The NHS chief executive, Sir David Nicholson, recently pointed out that although politicians say that the NHS has been protected financially, this is only relative to the extraordinary level of real cuts in other public services, and crucially, neglects the growth in the demand for healthcare—which, of course, always rises due to demographic changes and other factors. Also in 2015-16, around £3.8 billion, or 3.3% of the entire NHS budget, will be transferred from the NHS to local government as part of the ring-fenced “integration transformation fund”. There will in fact be a 2% real-terms cut in the healthcare budget in 2015-16; and we will have had a real-terms cut of 1.4% for the period from 2009-10 to 2015-16. The NHS is therefore expected to meet the demands of more and more people with less and less money. By international standards, the NHS is, as we know, a low-cost service.

The only way that such huge cuts could be achieved while improving or at least maintaining the quality of service to patients would be through major reconfigurations of services. However, progress with these essential changes is hampered by the activities of the competition authorities and the tendency of politicians to fight to preserve local services even when these are not viable.

To add to the pressures on GPs, £104 million of this year’s savings by local authorities is coming from the direct withdrawal of services. The number of district nurses has plummeted by 40% in the past decade—and as always when these things happen, the buck seems to stop with the GP. Some 87% of councils now respond only to needs classified as “substantial” or “critical” under the fair access to care criteria. As a result, the number of older people receiving publicly funded services has fallen by 26% since 2009-10. The decline has been 21% for working age adults. What this does to the economy as more and more people are sick and not obtaining treatment does not bear thinking about.

As a result of all this, GPs are experiencing ballooning workloads. It is apparently quite normal for a GP not only to work 11 to 12 hours a day—as many of us do—but to deal with 60 patients per day, some over the phone but most of them face to face. GPs regularly do this, day after day. I regard it as unacceptable to expect any human being to make complex and responsible decisions in relation to so many people each day. Any of those 60 people might be facing a life or death situation and the wrong decision could, in fact, cause them to die. The reality is that errors will be made. Patients will suffer as a direct result of the financial pressure on the NHS and therefore upon general practice. Some 49% of GPs say they feel they can no longer guarantee safe care for their patients. If our health service collapses the Government will find it incredibly difficult to achieve any of the objectives that the Minister set out today.

Any opinion poll will tell the Chancellor that rectifying the problem and reducing the risks to patients is a top priority for voters, and yet there was nothing in the Budget to alleviate these problems. I appeal to the Minister to draw these concerns to the attention of the Chancellor.