The NHS has to make savings of £20billion by 2012 and today David Nicholson has reminded colleagues in the service that they need to achieve this without cutting back on the services they provide.
So how might they do this?
Pass costs onto staff: Making staff work longer hours and / or for less pay; charging staff for ‘perks’ such as on-site parking; implementing zero hours contracts to maximise ‘flexibility’ (but leaving staff to absorb fixed costs such as childcare).
Pass costs onto patients: Require patients to self-manage more conditions (whether they want to or not); Increase or implement charges for parking, food & drink on hospital sites; implement or increase charges for ‘optional’ services such as baby scan pictures, skin-matching prosthetics, various ‘aids’ and equipment; increase commercialisation of hospital sites (e.g. Food outlets & newsagents).
Pass costs to other parts of the system: Increase “management overhead” charges to external commissioners (such as LA’s commissioning OT or SaLT services); implement or increase charges to external commissioners for providing holiday, sickness or maternity cover; raise charges to external commissioners above internal inflation rates; allow waiting times for elective surgeries to increase so that some patients self-select for private alternatives; reduce ‘preventative’ and other public health interventions that are not perceived as ‘acute’ services (generates costs later, but who cares?)
Make ‘hidden’ reductions to service quality: Reduce training / CPD; amend skill mix (i.e. work previously done by qualified staff now undertaken by non-qualified staff); run more services ‘solo’ rather than with paired workers (see also passing ‘costs’ to staff as this can sometimes place staff at personal risk); increase numbers of volunteers engaged in service delivery (e.g. with labouring mothers on delivery units); remove some ‘targets’ so aspects of service cease to be measured and related service reductions are invisible.