Monitor’s report into the finances of NHS trusts in England does not make for salutary reading, and confining the issue to the care offered directly by the NHS will only compound the problem.
Hospital, ambulance and other acute services are often the last stop on the health and social care journey, by which time a range of earlier, more suitable intervention opportunities have been missed.
Hospitals and other acute services are under monumental strain because of a failure to re-locate care away from the most expensive environments. The sudden slashing of public health spending earlier this year will see knock-on effects and pressures being applied to the NHS budgets in years to come.
A new consultation on the public health formula has just been released and practitioners up and down the country are studying the proposals to see exactly what they will mean for service provision. Unsurprisingly, there is a strong possibility that spending will reduce in real terms – some areas could lose as much as 15% of their funding. The short-sightedness of this move would be staggering. Add this to the uncertainty over exactly what constitutes a ‘health service’ ringfence in England and we can predict a diminishing health and social care sector with more and more effort concentrated on treating the symptoms of poor health, while the underlying problems stagnate.
Achieving the aims of the NHS Five Year Forward View will depend in a large part upon maintaining a strong, preventative public health system. Removing funding from areas like staff training, commissioning, early help and prevention will only unbalance our health care system even further. As we have seen with the deficits building in NHS Trusts, it only takes a slight destabilisation to put the whole system out of kilter.
Wirral is a Five Year Forward View new model of care vanguard. Our main challenge is working out how we get from the now to the new; time will tell what part the financial crisis plays in reducing the spaces between just getting by and innovation. Our first instincts are always for survival – but without radical change we simply won’t do it.
Fiona Johnstone, director of public health at Wirral MBC