Saving the NHS £20 billion

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. 

http://www.guardian.co.uk/society/2011/apr/12/nhs-chief-intervenes-ambulance-…

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.

Job done!

Happy now?

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