1. Undermining the NHS: the impact of the government’s cuts Rachael Maskell Head of Health Unite

2. The NHS 5 July, 1948 “not only is it available to the whole population freely, but it is intended … to generalise the best health advice and treatment” Aneurin Bevin, 1946

3. Cuts in the NHS to date 1949 – Prescription Charges (in place in 1951) 1974 – Introduction of Regional and Area Health Authorities 1982 – Area Health Authorities abolished and Districts re-organised 1983 – Start of competitive tendering for ancillary services 1989 – White paper – Working for Patients (NHS reforms) – proposes purchaser/provider split in the NHS, GP fundholders and a state-financed internal market. Also an efficiency drive 1990 – Market introduced with new Act 1991 – Health of the Nation, white paper – the patient is a customer 1994 – Regional Health Authorities abolished with reorganisation 1996 – 3 new white papers, Choice and Opportunity, Delivering the future, The NHS: a service with ambitions 1997 – The new NHS: Modern, dependable 2000 – The NHS Plan (10yrs) then 2001 Act 2001 – Star ratings 2002 – Reorganisation – District Health Authorities replaced by Strategic Health Authorities 2003 – Another reorganisation 2004 – Foundation Trusts created and another white paper – Choosing Health 2005 – Commissioning a patient led NHS 2006 – Reorganisation and cut in number of SHAs and Trusts 2006 – White paper – Our health, our care, our say. This was to oversee the expansion of the market in providing services in the NHS 2010 GENERAL ELECTION

4. Coalition Plans There will me no top down reorganisation of the NHS

5. Liberating the NHS? 2010 – White paper (July) 2011 – Health and Social Care Bill (Jan) ‘The Pause’ (Future Forum) Passage through parliament Professionals, Patients, Public – against 2012 – The Health and Social Care Act 2012 2013 – Mass reorganisation of the NHS Some services in meltdown

6. The new NHS

7. The Health and Social Care Act £3bn to reorganise the NHS 175 bodies now expanded to 400 Public health moved to local authorities CSUs not GPs in charge of the system – Vested interests Private Patient Income Cap of 49% Any Qualified Provider Fragmentation and constant change Current structures will implode Change in role of Secretary of State

8. ££££ Money ££££ PFI debt Efficiency cuts (savings) Foundation Trust additional savings £20bn Nicholson Challenge, more to come Cost of internal market £20m under last government – these costs will escalate More demands on the service, with increasing longevity Collapse of other support services previously supplied by Local Authorities and charities

9. The NHS staff Pay – freeze and cap Downbanding Pensions On Call NRRP Performance pay Removal of unsocial hours whilst sick Spot Salaries Remove accelerated progression 1/3 rd cut

10. Impact on staff Blamed for being uncaring and cruising NHS staff survey – 38% work related stress Low morale Would not recommend job Exhaustion – working unpaid overtime – some average 8 hours / week Impact on other wellbeing issues

11. Impact on services & patients THE SERVICE Reorganisation Fragmentation Record keeping and continuity Instability Financial considerations put first Prioritisation THE PATIENT Patient choice?? Postcode lottery Increased risk for patients Top up payments Confusion Emergency care

12. When you bring this together Too many conflicting agendas, too many vested interests, too many people who have control EXCEPT professionals and patients

13. At a cross roads Full insurance-based health system delivered by a range of providers. Postcode lottery and range of entitlements. Assessment on ability to pay Restore the NHS – publicly provided, publicly delivered, publicly accountable – free at the point of need for all where patients and professionals are at the heart of the service

14. Change needed for staff

15. The NHS When you are sick you need the NHS, now the NHS is sick the NHS needs you Unite “The NHS will survive as long as there are folk with the faith to fight for it.” Bevan

16. Questions Rachael Maskell Head of Health Unite @RachaelMaskell Rachael.Maskell@unitetheunion.org 0203 371 2009