Sir David Nicholson says extra £11.5bn spending means patient services should not be cut
Sir David Nicholson, the NHS's chief executive, has warned health bosses that patient care should not suffer as a result of the service's need to save £20bn by 2015.
The axeing of 560 frontline jobs by the London Ambulance Service forced Nicholson to issue his second reminder in 72 hours to NHS managers not to cut back on the services they provide.
It was the potential closure of ambulance stations in the capital and significantly increased use of solo paramedics to respond to calls that prompted his intervention. On Monday the Royal College of Nursing issued a dossier of evidence documenting 40,000 job cuts in the NHS and closure of services in areas such as mental health and alcohol dependency.
Increasing cuts to NHS services, caused by the service facing a range of serious financial pressures, are emerging at the same time as David Cameron and his health secretary, Andrew Lansley, want to show that they are listening to the widespread concerns about their planned shake-up of the NHS in England.
The revelation that more people are waiting longer to be seen in A&E departments, and that even specialist nurses who help patients with conditions such as cancer and multiple sclerosis are facing cuts, are further signs that the NHS is struggling to adjust to the toughest financial climate it has faced in a decade.
"It is critical that the NHS uses efficiency savings to make real improvements in the quality of care for patients – there is no excuse to reduce services for patients when the NHS will receive an extra £11.5bn of funding," said Nicholson. "Every penny saved from measures taken to reduce costs will be reinvested in patient care." That £11.5bn is the amount the Department of Health says is the extra cash that the government pledged in last month's Budget to invest in the service in England between now and 2015.
It has been told to make £15bn-£20bn of efficiency savings by 2015 – the so-called "Nicholson challenge". While the DoH insists that those savings should come from greater productivity and delivering healthcare in innovative ways, growing evidence suggests that access to certain treatments – including hip and knee replacements, hernia operations and IVF – is increasingly being either restricted or stopped altogether. Adapting to the next four years bringing flat budgets, or at best budgets that have increased by no more than ministers' pledged rise of 0.1% a year until 2015, is another challenge.
Doctors' and nurses' leaders, medical charities and patient groups claim the cuts undermine David Cameron and Lansley's promises to protect the NHS frontline and "cut the deficit, not the NHS". Dr Ian Wilson, deputy chairman of the British Medical Association's hospital consultants committee, said: "It is a pretence to keep saying that frontline NHS services are protected from cuts; so called efficiency savings in reality amount to cuts across the NHS, with a range of frontline services becoming increasingly stretched as money is taken out of budgets."
The BMA agreed with Lansley's decision last June to scrap the target that forced hospitals in England to treat everyone turning up at A&E within four hours of their arrival, Wilson added. But he also warned that "scaling back services in other parts of the NHS will make it harder for patients to get the right care in other settings, which is likely to increase the burden on A&E. The cuts to specialist nursing services identified by the RCN are a good example of that – a patient who gets the specialist care they need at the right time is far less likely to need to go to A&E."
Nigel Edwards, acting chief executive of the NHS Confederation, which represents hospitals, ambulance services and most of the NHS's other main employers, said: "There has been a relentless rise in the numbers of people using A&E and 999 services in recent years and this is putting real pressure on the NHS. Most hospitals will aim to get patients seen well within the four-hour target, and a well-run hospital will have processes in place to make sure patients are moved through the system swiftly and efficiently."