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The First Step in Manpower Cuts?
583
Commentary from Westminster The First
Step
in
Manpower Cuts?
THE gap between the Government’s picture of the NHS and the view of those who actually provide its medical care widens with each passing week and with every new Government policy initiative. The latest Government directive on manpower reductions has emphasised the split. Obediently seeking to make the 100 million cuts in this year’s health spending which the Chancellor demanded in July, the Social Services Secretary, Mr Norman Fowler, has sent health authorities a circular explaining how they should bring aboutareduction of between O.75% and 1% in NHS manpower. There must be a renewed drive, the circular urges, to achieve economies and cut jobs. Authorities should ensure there is a service justification for every post created. "In particular, no vacancy should be filled unless there is clear case for its continuation." The DHSS suggests that by next March authorities should aim to reduce their nonmedical manpower by between 1 . 35% and 1-8%. These non-medical posts are expected to decline more sharply than medical jobs. But in order to bring the total reductions up to 0.75—1% there will also have to be cuts in the numbers of doctors, dentists, nurses, and midwives, and professional and technical "front-line" posts. While the circular does not put any percentage figure on these losses, a DHSS spokesman calculates that a cut in the front-line category totalling about 0 .37% would be needed. That would result-if health authorities worked to these figures-in very small reductions in doctors’ jobs. The nursing and midwifery cuts suggested will probably be rather more keenly felt. The Health Minister, Mr Kenneth Clarke, has been doing his best to play down the importance of such reductions. The NHS, he maintains, ought to be judged on the quality of care it provides, and on the number of patients it treats every year. On both criteria, he argues, the service is plainly improving steadily. The manpower reductions were intended to maintain improvements in patient care. The aim is to improve services within the level of resources that the productive economy can finance. That is a view which providers of medical care find hard to swallow. Mr David Bolt, chairman of the BMA’s Central Committee for Hospital Medical Services,thinks services to patients must inevitably suffer from the cuts, since there are few front-line posts which health authorities can really do without if standards are to be maintained. The targets set for job reductions were quite arbitrary, from the medical point of view, the figures having been chosen to satisfy the Treasury. But the real damage would be done by the likely manner in which health authorities would try to reduce posts. Jobs which fell vacant, either by retirement or when the incumbent moved on, would remain unfilled. But these would probably not be the jobs that were-medicallyunnecessary. Mr Bolt believes that it will not be a case of health authorities saying "let us identify the areas where we could afford to reduce staffing". It was going to be done by the sheer chance of what happened to fall vacant. This chance would apply equally to consultant and to junior posts. It was rather like having the verdict first and the trial afterwards. Some BMA estimates put the likely losses of medical posts between 120 and 190. Mr Bolt warns: "I would be very surprised if this circular is the end of the process." Now that the Government has established the precedent for the first medical manpower reductions since the inception of the
NHS, it would be easier to direct health authorities in future years to make further such cuts. The chairman of the Hospital Junior Staff Committee, Dr Michael Rees, fears that as a result of the circular junior doctors could lose their jobs without the possibility of redundancy pay or other compensation, since most are on sixmonth or one-year contracts. The effect on the health service of these cuts would be disastrous. The NHS is already overstretched and underfunded, and further reductions in medical and nursing staff would affect both acute services and services for the chronically sick, and services for mental handicap and mental subnormality. Patients could expect a deterioration in the availability of care, especially in areas such as renal dialysis, special infant care, acute surgery, and geriatric care. "I am sure hospital junior doctors will feel both helpless and demoralised as they try to cope with an increasing demand with effectively decreasing resources." In the field, administrators’ heads are now spinning with the implications of the circular. Trent RHA, for instance, (one of the most underfunded health regions anyway), was planning to take on 1000 extra staff, of all grades, both medical and ancillary, in order to open next year five major new projects and several smaller ones. The major projects are: a new district general hospital in Chesterfield; a new general hospital on the outskirts of Leicester; a new mental illness unit at the present Leicester General Hospital; the first phase of a new district general hospital in Worksop; and the second phase of the Rotherham district general hospital. Staff must be appointed before patients are admitted, a Trent spokesman emphasised. Some staff are to be transferred from other units to the new hospitals, but 1000 new posts were judged to be indispensable for the adequate running of the new units. But the new edict from the DHSS means that only 110 new staff can now be taken on. At the start of September Trent RHA will meet to discuss the new situation, but at the moment there is considerable doubt about the future of some of the new units. "We really do not know now if they can be fully opened next year", the spokesman concluded. Strangely, in the face of what looks increasingly like the most serious situation ever faced by the NHS, the forthcoming party political conferences do not promise to add much to the debate about its future. The Conservatives have not yet published a detailed agenda for their conference in Blackpool on Oct 11, but little should be expected from them except congratulations to Mr Fowler on his latest circular and exhortations to get more sheets washed by private enterprise. No Liberal agenda for Harrogate on Sept 19 is yet available, but anyway the Liberal contribution to Parliamentary discussion of health has not been remarkable over the past ten years. The Social Democratic Party has published its agenda for Salford, on Sept 11, but it does not include any resolutions on the NHS. A Party spokesman explains that the Social Democrats are satisfied with the health policy agreed by their ruling Council for Social Democracy last January. Their leader, the former Health Minister, Dr David Owen, is likely, however, to refer to more recent developments in his closing speech to the conference. In contrast, the Labour Party’s annual conference, in Brighton on Oct 3, will debate the NHS at length. Without doubt there will be unanimous approval for the Labour prescription: elimination of private medicine, nationalisation of the pharmaceutical industry, abolition of all health charges to patients, restoration of all spending cuts since 1979, and an NHS expansion of massive and unspecified proportions, paid for by the unilateral abandonment of nuclear weaponry. RODNEY DEITCH
-
°
Commentary from Westminster The First
Step
in
Manpower Cuts?
THE gap between the Government’s picture of the NHS and the view of those who actually provide its medical care widens with each passing week and with every new Government policy initiative. The latest Government directive on manpower reductions has emphasised the split. Obediently seeking to make the 100 million cuts in this year’s health spending which the Chancellor demanded in July, the Social Services Secretary, Mr Norman Fowler, has sent health authorities a circular explaining how they should bring aboutareduction of between O.75% and 1% in NHS manpower. There must be a renewed drive, the circular urges, to achieve economies and cut jobs. Authorities should ensure there is a service justification for every post created. "In particular, no vacancy should be filled unless there is clear case for its continuation." The DHSS suggests that by next March authorities should aim to reduce their nonmedical manpower by between 1 . 35% and 1-8%. These non-medical posts are expected to decline more sharply than medical jobs. But in order to bring the total reductions up to 0.75—1% there will also have to be cuts in the numbers of doctors, dentists, nurses, and midwives, and professional and technical "front-line" posts. While the circular does not put any percentage figure on these losses, a DHSS spokesman calculates that a cut in the front-line category totalling about 0 .37% would be needed. That would result-if health authorities worked to these figures-in very small reductions in doctors’ jobs. The nursing and midwifery cuts suggested will probably be rather more keenly felt. The Health Minister, Mr Kenneth Clarke, has been doing his best to play down the importance of such reductions. The NHS, he maintains, ought to be judged on the quality of care it provides, and on the number of patients it treats every year. On both criteria, he argues, the service is plainly improving steadily. The manpower reductions were intended to maintain improvements in patient care. The aim is to improve services within the level of resources that the productive economy can finance. That is a view which providers of medical care find hard to swallow. Mr David Bolt, chairman of the BMA’s Central Committee for Hospital Medical Services,thinks services to patients must inevitably suffer from the cuts, since there are few front-line posts which health authorities can really do without if standards are to be maintained. The targets set for job reductions were quite arbitrary, from the medical point of view, the figures having been chosen to satisfy the Treasury. But the real damage would be done by the likely manner in which health authorities would try to reduce posts. Jobs which fell vacant, either by retirement or when the incumbent moved on, would remain unfilled. But these would probably not be the jobs that were-medicallyunnecessary. Mr Bolt believes that it will not be a case of health authorities saying "let us identify the areas where we could afford to reduce staffing". It was going to be done by the sheer chance of what happened to fall vacant. This chance would apply equally to consultant and to junior posts. It was rather like having the verdict first and the trial afterwards. Some BMA estimates put the likely losses of medical posts between 120 and 190. Mr Bolt warns: "I would be very surprised if this circular is the end of the process." Now that the Government has established the precedent for the first medical manpower reductions since the inception of the
NHS, it would be easier to direct health authorities in future years to make further such cuts. The chairman of the Hospital Junior Staff Committee, Dr Michael Rees, fears that as a result of the circular junior doctors could lose their jobs without the possibility of redundancy pay or other compensation, since most are on sixmonth or one-year contracts. The effect on the health service of these cuts would be disastrous. The NHS is already overstretched and underfunded, and further reductions in medical and nursing staff would affect both acute services and services for the chronically sick, and services for mental handicap and mental subnormality. Patients could expect a deterioration in the availability of care, especially in areas such as renal dialysis, special infant care, acute surgery, and geriatric care. "I am sure hospital junior doctors will feel both helpless and demoralised as they try to cope with an increasing demand with effectively decreasing resources." In the field, administrators’ heads are now spinning with the implications of the circular. Trent RHA, for instance, (one of the most underfunded health regions anyway), was planning to take on 1000 extra staff, of all grades, both medical and ancillary, in order to open next year five major new projects and several smaller ones. The major projects are: a new district general hospital in Chesterfield; a new general hospital on the outskirts of Leicester; a new mental illness unit at the present Leicester General Hospital; the first phase of a new district general hospital in Worksop; and the second phase of the Rotherham district general hospital. Staff must be appointed before patients are admitted, a Trent spokesman emphasised. Some staff are to be transferred from other units to the new hospitals, but 1000 new posts were judged to be indispensable for the adequate running of the new units. But the new edict from the DHSS means that only 110 new staff can now be taken on. At the start of September Trent RHA will meet to discuss the new situation, but at the moment there is considerable doubt about the future of some of the new units. "We really do not know now if they can be fully opened next year", the spokesman concluded. Strangely, in the face of what looks increasingly like the most serious situation ever faced by the NHS, the forthcoming party political conferences do not promise to add much to the debate about its future. The Conservatives have not yet published a detailed agenda for their conference in Blackpool on Oct 11, but little should be expected from them except congratulations to Mr Fowler on his latest circular and exhortations to get more sheets washed by private enterprise. No Liberal agenda for Harrogate on Sept 19 is yet available, but anyway the Liberal contribution to Parliamentary discussion of health has not been remarkable over the past ten years. The Social Democratic Party has published its agenda for Salford, on Sept 11, but it does not include any resolutions on the NHS. A Party spokesman explains that the Social Democrats are satisfied with the health policy agreed by their ruling Council for Social Democracy last January. Their leader, the former Health Minister, Dr David Owen, is likely, however, to refer to more recent developments in his closing speech to the conference. In contrast, the Labour Party’s annual conference, in Brighton on Oct 3, will debate the NHS at length. Without doubt there will be unanimous approval for the Labour prescription: elimination of private medicine, nationalisation of the pharmaceutical industry, abolition of all health charges to patients, restoration of all spending cuts since 1979, and an NHS expansion of massive and unspecified proportions, paid for by the unilateral abandonment of nuclear weaponry. RODNEY DEITCH
-
°