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‘Secret plans’ detail severe cuts across the NHS

BMA accuses NHS Improvement of driving through cuts to already overstretched services

Mark Gould

Friday, 28 July 2017

The BMA has accused health service leaders of refusing to publish details of plans which it says will mean severe cuts that could extend waiting times, reduce access to services, prescriptions and treatments, and even merge or close hospitals and facilities.

The Capped Expenditure Process (CEP) was introduced in April 2017 and instructs NHS commissioners and providers in 13 areas across England with the largest budget deficits to make considerable cuts in order to achieve financial balance by next April.

The areas affected by the CEP are under intense pressure to drastically reduce spending by around £500 million, and health leaders have been told to ‘think the unthinkable’ with regards to cuts.

The chief executive of NHS Improvement, Jim Mackey, has said the areas selected for the CEP had the largest gap between their planned expenditure for 2017/18 and their budget allocation. The areas involved, which stretch from the South West, through London, the Midlands, the North East and North West, have submitted cost reduction plans to NHS England.

The BMA sent Freedom of Information requests to NHS Improvement and each of the 13 areas, requesting the proposal documents. It says NHS Improvement told the BMA that the documents belong to local health authorities and suggested requests were forwarded to those organisations.

The BMA then wrote to organisations in each of the areas requesting the final return – or the details within if not the whole documents. Representatives from just eight of the 13 areas responded and none provided the full document or any significant details of their plan. 

BMA council deputy chair, Dr David Wrigley, said: “These plans could have serious consequences for doctors working on the frontline and for the care and treatment patients receive and can expect in hospitals and GP surgeries in these areas.

“It is bad enough that brutal cuts could threaten the services but it is totally unacceptable that proposals of this scale, which would affect large numbers of patients, are shrouded in such secrecy.

“This government must stop and think before pressing ahead, as cuts on this scale in this timeframe would have a devastating impact on patients and staff. Our NHS is one of the very best healthcare services in the world, with hugely talented staff but it relies too much on the goodwill of the staff who dedicate their lives to helping patients. This simply cannot go on. The government must provide adequate funding for the health service before it is too late.”

The BMA says one anonymous trust chair with oversight of the process of drawing up the plans in his area, told them he felt local leaders were being bullied:

"We were descended on and asked to think the unthinkable in no time at all. The NHS seems to go into a zone of secrecy as an automatic reaction. That’s the thing that really upsets me – the secrecy of it all and the ridiculous pace in which solutions are to be crafted and agreed. It’s the management culture too – it’s all hierarchical power and bullying. Even the most modest proposals would cause uproar.”

An NHS England spokesperson said: "While this report is just recycling old claims from several months ago, the NHS has always had to live within the budget that parliament allocates, and the usual requirements for public consultation on any suggested major service reconfigurations of course continue to apply. However it's grossly unfair if a small number of areas in effect take more than their fair share at the expense of other people's hospital services, GP care and mental health clinics elsewhere in the country."

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