If you did not have a head for figures you would be forgiven for thinking that Cornwall's Sustainability and Transformation Plan (STP) heralds in a brighter and healthier future for the people of Cornwall. But hidden amidst the spin about “taking control”, “golden opportunities” and “improving the quality of health and social care services” is £264 million cuts.
During the consultation, these cuts will be presented as a fait accompli imposed by an unmovable government. But governments can be moved. History is full of examples of governments that changed course due to public pressure. Just last year the government performed 24 U-turns due to pressure from the Labour Party. Theresa May's government is especially vulnerable. It has a slim majority and is facing a renewed left-wing Labour party with half a million members. Across the country people are waking up to the crisis in the NHS, a crisis created in Downing Street.
Cornwall's £264 million cuts are the government's finale to the most austere decade in the NHS's history. It is part of £22 billion cuts they are imposing on the NHS as a whole as they reduce NHS spend from around 9% GDP under Labour to just 6.7% GDP by 2021. It comes after the 2010-15 Tory-Lib Dem coalition imposed £20 billion cuts and implemented the biggest top-down reorganisation in NHS history. This reorganisation, the Health and Social Care Act, was designed to make it easier to privatise the NHS. The NHS now has fewer beds and fewer doctors per person than most European countries. Private health firms are enjoying boom times.
According to the Red Cross - an organisation not known for hyperbole - the NHS is already in the midst of an 'humanitarian crisis'. The NHS has been kept afloat for the past 6 years by the hard work and commitment of NHS staff. They have received no thanks. Between one third and a half of the 'savings' over the 5 years of Tory-Lib Dem rule came out of the pockets of NHS staff whose wages have dropped on average by 12.3%.
The NHS crisis is seen most acutely in A&E. Between March and May 2016 Treliske was on black alert for 32 days and red alert for 54 days, leaving just 6 days when the hospital was running normally. A&E is the 'canary in the mine' for the NHS. If there are problems in A&E then there are problems throughout the whole health and social care system.
For the past six years, experts have been arguing that savings could be made by shifting care from expensive hospital beds to cheaper nursing and social care in the community. However, social care has been cut to the bone by councils struggling to manage cuts from central government. That means frail patients cannot be discharged to the community. The same patients without care and support in the community end up in A&E. As health and social care services have shrunk as a result of government austerity, more and more people end up in A&E as a last resort and often with more serious and complicated conditions. People who have been admitted to hospital struggle to be discharged due to a lack of appropriate supported accommodation. In Cornwall 35% of community hospital bed days are used by patients who are fit to be discharged but are stuck in hospital due to a lack of appropriate social care.
Cornwall's STP does accept the need for more social care placements and there is some increase in funding planned. However even by their own projections this still leaves the council budget £28 million short of what is required. Since October 2015 Cornwall has lost 9 care homes, a total of 109 beds. Care home providers said they could no longer afford to operate at the miserly rates the council pays for social care. Yet part of the STP relies on further reducing the cost of social care beds. It is impossible to see how this is workable.
The plan also hints at privatisation of the NHS. There is great concern that Cornwall routinely sends mental health patients out of county for hospital admissions. There is a national shortage of mental health beds and the entire sector is reliant on private hospitals. Cornwall's provision is permanently stretched. The crisis of mental health beds often means that it is difficult to find a bed anywhere in the country. Cornwall's mental health patients can find themselves transported hundreds of miles in search of a bed. More often than not these long journeys occur at the point of admission, when the patient is at the height of mental health crisis. It is welcome that the plan acknowledges the problem but the solution appears to be an “alternative service model” which sounds suspiciously like privatisation.
The cuts are not necessary. Neither do they make good economic sense. The government treats the NHS as a black hole for government finances, driving up government debt. The opposite is the case. The NHS is an engine of the economy, creating not only healthy people but also plenty of NHS workers who spend their wages in the local economy. In Cornwall the NHS is the largest employer. Any cuts to the NHS will have a knock on effect on the rest of the economy, bringing down tax revenues.
Beyond this, as the NHS faces a mortal crisis there is a need for us to ask ourselves what sort of society we want to live in. Since 2009, the richest 1000 people in Britain increased their wealth by 112% to £576 billion. A fraction of this wealth would provide the NHS and social care system with enough money for decent care for all. But instead of organising emergency funds for the NHS and Social Care, the government used the last autumn statement to offer tax breaks for these very same billionaires. The choice facing each and every one of us is whether we want riches for the few or decent healthcare for everyone.