Forum topic: Council leaders cry foul over cost-cutting plans for NHS in North Central London

In defiance of instructions not to do so, two North London councils have published draft proposals for cost-cutting changes to NHS services in the five "North Central London" boroughs - Camden, Islington, Haringey, Enfield and Barnet.

"Lack of public, patient and political involvement"

Councillor Sarah Hayward, leader of Camden Council, took this step because of her "serious reservations" about the process used to draw up the proposals.  In a statement published on her council's website she writes: "There has been no political oversight, and minimal public and patient engagement. At present, there is a lack of appropriate focus on adult social care. That lack of public, patient and political involvement is why I am publishing this document on our website. It is vital that there is full transparency in Camden as this work progresses."

Cllr Hayward's views were echoed today by Doug Taylor, leader of Enfield Council, who added, "Enfield Council believes that the best way to move the process forward is through an honest and open conversation with local people about what the proposals will mean for them.  I urge everyone to make their views known.”

"Allow the people of Enfield to have an informed opinion"

Cllr Taylor's move was welcomed by local campaigning group Defend Enfield NHS.  Yesterday Louise Nicholson wrote to the Council Leader on behalf of the group, asking him to "allow the people of Enfield to be able to access the full information to enable them to have an informed opinion".

The document which is now available on both councils' websites is the draft North Central London Sustainability & Tranformation Plan (STP), as submitted to NHS England by NHS organisations in the five boroughs.  The North Central London STP is one of 44 that are being drawn up, covering the whole of England.  NHS bodies and local authorities in each of the 44 "footprints" have been ordered to collaborate in drawing up radical plans for health services in their area.

Funding gap

The purpose of the STPs is to devise changes to the way health services are provided which will provide better health "outcomes" for people living in the "footprint", while at the same time significantly reducing the cost to the Department of Health.  The stipulation is that the STPs must cut costs by £22 billion per annum over the country as a whole - representing the difference between the cost of providing NHS services using current practices and the actual amount of funding which the government is prepared to allocate to the health service - the so-called "funding gap".

The introduction to the draft STP makes clear the financial challenge:  "Demand for health and social care continues to grow year on year and the growth in demand is running faster than the growth in funding. If we do nothing, we estimate that we would face an unprecedented financial gap in relation to health services alone of nearly £900m in NCL by 2020/21. In addition, as is well known, the trend is for people to live longer and in turn this is creating pressure on social care services and funding."

The most important proposals contained in the draft STP are summarised in a report in the specialist journal National Health Executive.

Painful cuts

Seeking better and more cost-effective ways of providing health outcomes is something that the NHS has always done, but many expert observers consider that the scale of savings being demanded by the government cannot be achieved without some painful cuts to services.  So it is no surprise to find that the proposals in the draft - despite including some which "can be challenging to implement and controversial with the public" - would not produce the required savings:

"Delivering these plans will result in improved outcomes and experience for our local population, increased quality of services and significant savings.

"Despite this, we currently expect that the overall financial position of NHS organisations will be a £75m deficit in 2020/21. We have identified a number of areas for further work between now and Christmas where we believe there may be additional savings to be found that would address this residual gap."

"Underfunded, not overspending"

Is the financial crisis currently inflicting the whole of the NHS in England the result of inefficiency and profligacy?  That's certainly the impression that the government likes to give.  But Defend Enfield NHS point out that the percentage of GDP that we apend on the health service is the lowest in western Europe and even below that of Greece.  As Louise Nicholson puts it, the NHS is "underfunded, not overspending".

This article was amended at 22:30 on 26th October after the draft STP was posted to the Enfield Council website.