The announcement relates to the ‘Capped Expenditure Process’ (CEP) which was introduced in April and asks NHS Commissioners in 13 areas across England to make considerable cuts in order to make up for budget deficits.
The areas affected include Cheshire and Merseyside, several areas in the South West including Bristol, Somerset and Devon, as well as three London CCGs. These areas are reportedly expected to cut spending by £500 million by April next year.
The BMA criticise the fact that the CEP has not been announced publicly and say only limited details have been made available. The Association contacted CCGs directly to request copies of their proposals but only eight responded, none providing significant details of their plan.
The BMA says it is ‘deeply concerned’ by the secretive nature of these plans, and suggests the consequences of further cuts to already stretched services could include redundancies, rationing of services, increased waiting times, reductions in referrals and even closure of services.
Supporting these claims, a recently leaked documenton CEP cuts in London revealed a range of options including increasing the maximum for planned operations (which currently stands at 18 weeks), hospital units being downgraded or shut altogether and a major cut to the Continuing Healthcarescheme, which offers financial support to vulnerable patients with long-term medical problems and disabilities.
BMA Council deputy chair Dr David Wrigley described the planned cuts as brutal: ‘These plans could have serious consequences for doctors working on the frontline and for the care and treatment patients receive and can expect in hospitals and GP surgeries in these areas.
It is bad enough that brutal cuts could threaten the services but it is totally unacceptable that proposals of this scale, which would affect large numbers of patients, are shrouded in such secrecy.’
Provide funding ‘before it is too late’
Senior leaders involved in creating the plans say they are frustrated by the ‘ridiculous’ secrecy of the process and suggest even the more moderate proposals would ‘cause uproar’.
An anonymous contributor said they were asked to ‘think the unthinkable’, adding ‘the NHS seems to go into a zone of secrecy as an automatic reaction. That’s the thing that really upsets me – the secrecy of it all and the ridiculous pace in which solutions are to be crafted and agreed’.
Agreeing with this, BMA deputy chair Dr Wrigley says frontline staff should be at the centre of the plans but were ‘frozen out’ of discussions, and called on the government to rethink the plans:
‘This government must stop and think before pressing ahead, as cuts on this scale in this timeframe would have a devastating impact on patients and staff. Our NHS is one of the very best healthcare services in the world, with hugely talented staff but it relies too much on the goodwill of the staff who dedicate their lives to helping patients. This simply cannot go on. The government must provide adequate funding for the health service before it is too late.’
However, NHS England say the cuts are nothing new: ‘The NHS has always had to live within the budget that parliament allocates, and the usual requirements for public consultation on any suggested major service reconfigurations of course continue to apply.’
The NHS suggests areas shouldn’t take ‘more than their fair share’ at the expense of other services, and Chief Executive Simon Stevens said last week that the CCGs ‘need to get on with’ making the planned savings.