East Sussex Better Together – breaking bad news gently

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Within the Sussex and East Surrey region which comes under the Footprint 33 STP Board there is a large population, covering a wide geographical area with many health inequalities.  For this reason the STP has been divided into three place-based plans.  East Sussex Better Together (ESBT)  is the place-based plan that will affect us.

ESBT have now published some proposals for how over the next five years they will  make health and social care sustainable – more detail will follow.  The proposal details how East Sussex Healthcare Trust, East Sussex County Council (ESCC) and  the CCGs for Eastbourne, Hailsham and Seaford as well as Hastings and Rother have all agreed to work together in this aim with Sussex Partnership Foundation Trust as  an associate in the alliance.

Towards the start of their document they include the sentence that: “While the cost of providing health and care increases the resources available to fund these services cannot grow at the same rate.”  This is a statement that some would disagree with although most people would agree that we should never shun any proposal that would make delivering healthcare cheaper.

Many initiatives have been suggested across the country to reduce healthcare spending apart from the elephant in the room.  This particular elephant being the obviously sensible idea of returning our healthcare system to the one that we know delivers the most efficient and equitable means of providing our nation with healthcare – the system our NHS was founded on.

Funding healthcare is about ensuring that the population is granted one of the rights enshrined by the Universal Declaration of Human Rights.  The human cost of being unable to get the healthcare we need is immense.  If the issue of whether we should show a shred of humanity doesn’t grab you then perhaps the economic argument will?  How can our population work and deliver lasting prosperity to our country if illness is being left untreated?

But following the Five Year Forward View issued by NHS England, in response to the escalating deficits of NHS trusts and commissioners, these STP proposals that dress up cuts to make them look positive are being published in every region of England.  Our region is no different.

The proposal of ESBT managed to include something about aiming to offer people treatment in their own home rather than hospital so many times that the word ‘repetitive’ does not seem to be an adequate description.    It would strike me as common sense to say that treating sick people spread all around the town in their own homes can only be more expensive than treating them all in a hospital.  But somehow this concept is being sold by ESBT as something that will cut costs.  The only way it will cut costs is if patients are not treated in their own home or hospital, but perhaps they recognise that idea would be harder to sell.  This stinks of Maggie’s ‘care in the community’ policy that simply resulted in no care at all for many.

The proposals have been formed by first looking at a ‘do-nothing deficit’.  This figure relates to the difference between the forward projection of healthcare spend if nothing is changed against the current funding level of healthcare.  This gap between the current funding level and the level of health and social care spending across East Sussex is predicted to be £240m by 2018/19 unless we do something drastic to cut the spending.

The drastic ‘something to cut the spending’  that ESBT propose will mean a 19% gross reduction on commissioner spend which will equate to a reduction of £153m in East Sussex (commssioners for East Sussex are the two CCGs and ESCC).  They intend to cut:  £87m from acute services, £13m from community services; £11m from mental health; £21m from prescribing and £21m from other services.  Regulations require that £34m will be re-invested in the local services.

I don’t know about you but that scares the life out of me.  The ‘do nothing’ deficit is simply the level at which Government is underfunding our local health and social care services.  The squeeze on social care which largely stems from the underfunding of our local authorities accounts for £118m of this deficit.  This explains why austerity doesn’t work.  When one public services is given inadequate funding pressure is placed on another service.  ESCC is in year 2 or a three year programme to make £27.8m of savings.

So many of the austerity measures we have already seen are creating severe hardship but are actually costing our country money as opposed to saving money.

Take for example the sanctions regime.  To administer the scheme is costing tax payers £285m annually, but it saves just £132m in welfare payments.  Imagine the hardship and the desperation people must feel when their income is reduced to nothing ( I Daniel Blake is a must see film if you want to understand).  Think about exteme poverty and ask yourself: How can a person who is working be productive at work if their income is zero?  How can a job-seeker be productive? How can a parent care for their kids? How can a person look after their health? Now you may see why austerity doesn’t work.  Why can’t our Government stop paying to create hardship and pay into the NHS instead?

There is no further detail yet about how exactly ESBT intends to change our services in order to make the savings they have detailed in this document.  They have discussed multi-disciplinary teams working together and made some vague statement about how for some people the changes may mean travelling greater distances to get the treatement they need.  The figures released for the scale of cuts proposed by ESBT are bad news but I fear that when the details of how they intend to make these cuts are released it will be even more frightening.

Any cuts to mental health are supposed to be re-invested  in mental health but I know many in East Sussex are already highly critical of the service that Sussex Partnership Foundation Trust offers.  It has been a source of great frustration for me that NHS campaigns rarely seem to focus on mental health.  The success of treatments for mental health is strongly linked to the patient’s own personal circumstances.  With poverty, inequality, housing problems, and poor work opportunities escalating it would make sense to invest heavily in mental health.

We must start to fight these proposals, sooner rather than later.


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