BBC Radio Stoke has interviewed Andrew Donald, Accountable Officer of Stafford and Surrounds, Cannock Chase and South East Staffordshire and Seisdon Peninsula Clinical Commissioning Groups, about the challenges currently facing the NHS and the changes that need to be made via initiatives such as STPs to improve services.
The interview was broadcast at 5.20pm on Friday, February 10, 2017. It followed media reports that Sir Robert Francis QC - who chaired the Mid Staffordshire NHS Foundation Trust Public Inquiry – was warning that current pressures in the system were making the chances of another Mid Staffordshire-type breakdown more likely.
Drivetime Show presenter Stuart George started by asking his audience the question: “Is there an existential crisis in the NHS?” quoting Sir Robert.
BBC Radio Stoke then featured a brief recording of Sir Robert, who said: "The challenges he (Jeremy Hunt) faces are particularly acute at the moment but they are very similar to those faced by all health secretaries and what worries me is that it is possible through short-term solutions - by just giving more money - to provide temporary relief. But the fact of the matter is that we have an increasing population and an increasingly ageing population and we cannot carry on providing services in the same way that we did many years ago. So we have to find different ways of doing this.
"Many of the solutions so far - piecemeal though they are - make a difference and will keep this ancient machine going for a bit longer. But sooner or later there will come a tipping point and I have said that I think the service is facing an existential crisis."
Stuart explained that Health Secretary Jeremy Hunt doesn't think so and played a quote from Mr Hunt, who said: "I think you have to recognise that overall there are positive things as well as negative things and there is a huge commitment in the NHS to sort out those negative things.
“And the particular pressure point we have is A&E and what we need to do is find ways of treating particularly people with complex conditions - older people with dementia - treating them at home or in the community and that is the big direction of change we've embarked on.
"We have a very good plan and we have the support of the NHS. It will take time to deliver and also they need the public's help because we know that a number of the people who are seen at A&Es could actually have their needs dealt with in another part of the NHS."
Stuart then introduced Andy Donald, the chief officer of Stafford and Surrounds CCG, the people who pay for NHS services. The interview went as follows:
Stuart: Andy Donald, to what extent is Sir Robert Francis right when he says there's a crisis looming?
Andy: I think the difficulty is that people use lots of words to describe the health service. I think there's a problem in the health service and it's a problem related to the number of people who now need healthcare and the money available to give them that care.
Stuart: Is it that the health service is underfunded then?
Andy: It's not that it's underfunded. What's happened since 2010 is that obviously the costs of healthcare rise by about 4% a year and funding has not gone up by 4% a year - it's as simple as that. So if you look at say a 1% funding against a 4% increase you will eventually - even with efficiencies - get to a problem where there's not enough money in the system.
Stuart: If you've got a 4% increase year-on-year but you're not matching that with the budget at some point, as Sir Robert Francis says, it will break?
Andy: It possibly will, but there are two questions you've got to ask with regards to that, which are well what have we done differently to actually manage with the money that we've got and one of the real challenges in the health service is that we continue to provide services in the way that we've always provided them and we haven't yet transformed those services to take account of the fact that people are getting older. You know, the NHS is a good news story - people are living longer, but that news is that they're living longer sicker and with more complex needs. Therefore we've got to transform services to focus on those individuals and those more complex needs, thereby changing the way that services are provided and actually using the money better.
Stuart: The CCGs pay for many NHS services - to what extent is the problem in social care, which is dealt with mostly by local councils?
Andy: Well there's no doubt there's a problem. Social care isn't the problem - the problem is the funding in social care has gone dramatically down and that ultimately affects the NHS because if you can't keep people at home with appropriate care and you can't get them out of hospital with appropriate care then the system itself blocks up. And the consequence of that is that you get people waiting in A&E departments.
Stuart: So what needs to happen? You backed away from a crisis but you say there's a problem - how do we solve it?
Andy: Very simply, the first thing that needs to happen is that people look closely at funding social care because actually if we put some more resources into social care that might actually help us deal with the current problems. But what's also needed is that the system needs to transform and what happened is that we were given lots of money between 2003-2010 but we didn't transform the service then - we kept it the same - but now when we've got no extra resources we're trying to transform services. And in Staffordshire I use this quote a lot, whether it's right or wrong, I say it feels like we're driving a Rolls Royce when we can only afford a Mini. And actually there's nothing wrong with a Mini but we have to make choices about how we best use the money that we've got available to us - but when it comes to social care I think there's a shortage.
Stuart: Who do we need to address that?
Andy: I think from a social care point of view I think that centrally the Government need to address that and NHS England have been quite clear that if there were any resources for health and social care they thought that the first call on that should be for social care and I agree with them.
Stuart: So from what you've said there, is not funding social care adequately a false economy because effectively you're just taking money out of the health service to prop people up at the other end?
Andy: In effect that's exactly the situation you get with the cuts that councils across the country have suffered in terms of social care. Now, the Government would argue that they've put more money into social care by allowing the councils to increase council tax but that's not going to be enough.
Stuart then thanked Andy and said that local councils generally funded social care and that again we were hearing the message that social care isn't working, it's not got enough money, and that there were problems in the system.