ON THE EVE of its 50 birthday, the National Health Service is under massive pressure.
As health authorities and Trusts grapple with the cuts in spending required to balance the books by April 1999, indications from around the country suggest a new concerted manadement drive to reduce the number of front-line acute beds and slash the number of general and community hospitals.
Health Secretary Frank Dobson's obvious embarrassment at the government's breach of its far from ambitious promise to cut waiting lists for hospital treatment is leading to a series of mutually incompatible and increasingly impossible demands on NHS Trusts.
On the one hand he has insisted that they prioritise emergency treatment, and the new government's allocation of £300m last winter was specifically targeted in this direction. But with ever fewer beds remaining open in hospitals, priority for emergency admission necessarily means delaying the admission and treatment of "elective" patients on the waiting list. Now ministers have thrown in another lump of money, with orders that it should be used to reduce the numbers waiting: but with only peanuts to spend -insumicient to open extra beas -this must mean that the extra patients "cleared" from the waiting list will be only the cheapest and most minor cases, who can be treated as day cases and sent home to nurse themselves. Meanwhile health authorities seeking to minimise the size of waiting lists are resorting to other, more covert measures, including the wholesale exclusion of certain types of treatment, and imposing strict limits on the numbers receiving certain types of operation. Dobson's attempts to resolve were from areas which have forthe problem of "bed blocking" by giving extra cash to social services to arrange the discharge of frail elderly patients to nursing homes is also riddled with contradictions. Lack of suitable places, social service budget cuts and the weakness of GP services are leading to ever more elderly patients filling the beds which Dobson's cash emptied last winter. Meanwhile the NHS has increasingly abdicated from any responsibility to provide continuing care for the frail elderly - the generation which built and paid for the NHS.
While this represents a major change from the NHS since the time of its foundation, one area which has been constantly neglected is mental health care. Since 1961 successive governments have spoken of the advantages of community care -but failed to deliver the cash required to make it work.
New Labour is no exception and campaigners are furious On the campaign trail: 12,000 marched through Kidderminster to defend their hospital against closure as Worcestershire HA seeks to axe over 300 beds. that the £500m they had been led to expect for mental health services over the next few years will not be available: only a fraction of this amount will be grudgingly handed over. The carefully leaked rumours that tight-fisted Gordon Brown was about to come up with a £6bn or £8bn handout for the NHS should also be taken with a shovel-full of salt. Such sums would be significant if provided over and above inflation: but if NHS spending is to rise by only £6bn in cash terms over the next three years, this would represent a bigger cut than the Tories ever made.
The heat is on. Labour wants health authorities to balance their books by next year so that they can persuade increasingly sceptical GPs to take over a growing responsibility for purchasing services. But the desperate measures required to cut around £500m from spending during a single year has triggered angry campaigns across the country, while it threatens to axe more health workers jobs. As NHS bosses pass round the vol-au-vents and sing hymns in the church services to mark the NHS birthday, they will be keeping their calculators warm for the next round of cuts. £6-£8 billion above inflation would be a real birthday present for the NHS: anything less will be another miserable betrayal of Labour's mandate for change.
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