Hunt warns Government will step in if local NHS chiefs make ‘wrong choices’ over care

The Government will step in when it thinks local NHS leaders have made the “wrong choices” about care being rationed in the health service, the Health Secretary has warned.

Jeremy Hunt said decisions about how services are run are best made locally, but he said he was sending “strong signals from the centre” that efficiency savings in the NHS should not be made through reducing access to services or treatments.

He reiterated that the NHS is free at the point of use, adding: “We are absolutely determined to give people the care that they clinically need.”

The comments come after a number of reports of care being rationed in various parts of the country such as proposals to deny non-life threatening surgery to the obese and smokers, and limitations on fertility treatment.

Mr Hunt made the comments as he was grilled by MPs on the Health Select Committee about NHS finances.

When questioned on reports of rationing in the health service, Mr Hunt said it was facing “massive pressure”, adding: “Indeed there are painful and difficult efficiency savings, the extra £8 billion that the NHS said was the minimum they needed in the Forward View, coupled with it a need for £22 billion of efficiency savings. And making savings on that scale is never easy.

“What I don’t accept is that in order to make those efficiency savings you have to make changes that will impact negatively on patient care.

“I think that there are, of course, easy ways to make savings – which is to reduce the availability of care for patients – and there is the harder way, but the right way, which is to find ways that improve care and improve efficiency at the same time.

“Things like if you get an infection when you have a hip replacement that will cost the NHS £100,000 to sort out as well as being incredible painful and horrible for the patient concerned.

“There are ways we can improve clinical practice – there are ways that can catch cancers earlier. We know that it can be two to three times cheaper to catch a cancer at stage one than at stage three or four.

“So there are lots of things that we can do but I don’t accept that in order to make these efficiency savings we need to reduce the quality of care for patients, in fact I want to carry on increasing quality of care for patients.”

He said decisions about service provision are best made locally but added: “When we do hear of occasions when we think the wrong choices are being made, when an efficiency saving is being proposed that we think would negatively impact on patient care, then we step in.

“Because challenging though it is, our responsibility to the public is to make sure that we continue to make the NHS safer, of higher quality and offering a higher standard of care and we absolutely believe that is possible.”

He continued: “Where we hear about standards of care that are not meeting clinically agreed standards then we step in.”

Mr Hunt added: “When we hear evidence of rationing happening, then we do something about it.

“It is very challenging on the frontline now for everyone but we are very clear that the principle of the NHS is that it is a service that is free at the point of use and we are absolutely determined to give people the care that they clinically need.

“The NHS is the fifth largest organisation in the world and there are variations in the quality of service delivery in different parts of the country.

“What we try to do from the centre is to send out a strong signal that what we are looking for is not the easy efficiencies that can reduce the quality of care or access to services or access to treatments, but the efficiencies that actually improve care.”

Meanwhile, NHS England chief executive Simon Stevens told MPs that the next three years would be difficult financially for the NHS.

He said 2018/19 will be particularly difficult as there will be “negative per-person NHS funding growth in England”.

Mr Hunt told the committee the NHS was “not awash” with cash but he added that financial pressures are more acute in the social care sector than the health service.

Last week, the health and care regulator, the Care Quality Commission, called for more funding for social care which it said was reaching a “tipping point”.

Mr Hunt said that the report was “sobering reading” but refused to be drawn on commenting about the contents of the forthcoming Autumn Statement and whether or not it could produce more funding for health or care.

Mr Stevens said the NHS needed between £8 billion and £21 billion over the years covered in the health service’s Forward View.

He said: “The original modelling suggested an NHS funding requirement in five years’ time of between £8 billion and £21 billion, depending on the level of efficiency which could be produced, the continuing availability of social care relative to rising need, the availability of capital investment to lubricate new service models – particularly investments in GP services and out of hospital care – and the availability of preventative services through local authorities, but also the role the NHS itself has to play.”

Mr Stevens said he had previously given evidence to the Public Accounts Committee about the five years covered in the Spending Review.

He said: “For this year, year one of the Spending Review, we did indeed get the kick start to the funding that we broadly speaking were looking for, which we needed because we had to absorb nearly £1 billion of extra pension costs as well as the pressures in the provider sector coming out of last year.

“With that kick start settlement this year we are going to be able to cut the hospital deficit by more than two thirds, we are going to bring some stability back to many parts of the service that are under pressure and we are going to be able to make some modest starts to the improvements that we know are needed in mental health services, in cancer and primary care services.

“So that’s year one. Turning to year five, within the range of £8 billion to £21 billion, we did get within that range, albeit the lower end of the range, obviously the extent to which that can work depends on those other criteria working with us over that period.

“So for year one and year five, yes I think you can say we are in the zone.

“But for the next three years we didn’t get the funding that the NHS had requested, this is not a controversial statement, this is what I have already said to the Public Accounts Committee so it is not a new statement, so as a result we have got a bigger hill to climb.

“It’s going to be a more challenging 2017, 2018, 2019/20.”

He added: “So given we have got an ageing and growing population. If you look at the population growth, even before you take into account ageing, 2018/19 will be the most pressurised year for us where we will actually have negative per person NHS funding growth in England, but for the other years we will have very modest increases.”

When asked if that was the year he was particularly concerned about, he said: “That’s the maths.”

Commenting on the hearing, Jonathan Ashworth, Labour’s shadow health secretary, said: “We now know the truth: the Tories have failed to give the NHS the money it needs to protect patient care.

“Despite all of the Government’s spin, the chief executive of the NHS made clear that the NHS did not get the funding it asked for over the next four years and has a ‘hill to climb’ to maintain current services.

“The dramatic decline in NHS finances over the past few years has left A&E departments at breaking point, hospital wards dangerously overcrowded and millions of patients having to wait months for essential operations.

“Theresa May needs to stop ignoring the warnings from NHS bosses and start taking action to address the cash crisis facing the health service.”

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