Sir David Nicholson says service needs significant shakeup alongside £30bn in savings over next eight years
The NHS in England faces a number of patient safety scandals unless there is a significant shakeup in the service that has seen unused hospital wards close, hi-tech surgery centralised and GPs banded together into bigger practices, the chief executive of the health service has said.
Warning that the NHS would face an ageing population, more people suffering from long-term conditions and a stagnant budget, the service's outgoing boss Sir David Nicholson said it would need to make £30bn in savings over the next eight years. He said cuts alone were not an option: "There is a limit to how much more can be achieved without damaging quality or safety." He gave the example of paying below-inflation rates of pay, which could save £8bn but would demoralise staff.
Nicholson said the result of such a scorched-earth policy, which has been implemented in Ireland, would mean paring back the NHS to dangerous levels. "If we allowed things to go on, we would squeeze hospitals more and more," he said. "As 75% of spending is on staff we would be looking at reducing staff on wards. That would have a really bad effect on patient safety."
He added it was "exactly the case" that to continue to "muddle along in the NHS" would mean "many more Staffords", a reference to the scandal of poor care at the Mid Staffordshire hospital.
Instead Nicholson argued the country had a window of opportunity to act and would be writing to all 211 clinical commissioning groups, family doctors who commission care on behalf of patients, to ask them to produce "three to five plans" to make savings of 5% annually by the end of the year.
Nicholson said NHS England could not cut funding for fundamental services, as Greece has done, or face privatisation. He said: "Charging patients or making co-payments aren't consistent with the NHS constitution."
That leaves dismembering hospitals and reshaping GP practices. Key to this is the centralisation of services – where care is concentrated in a few specialist centres. NHS England's medical director, Professor Sir Bruce Keogh, said that a number of services had the potential to be concentrated at fewer specialist centres, such as treatment for heart attacks and strokes, operations on veins and arteries and bowel surgery.
While London has led the way in centralising services – reducing the number of stroke centres from 24 to eight – Nicholson said that in the West Midlands and Manchester there had been little change.
In the past campaigners have derailed attempts to close down hospitals. There have been legal challenges to closures in south and west London. Last month health secretary Jeremy Hunt halted plans to shut three children's heart surgery units, a reconfiguration supported by most medical bodies and which was first proposed in 2001. Nicholson said he had come to the conclusion that these closures had failed because, driven from the centre, they could not command public support.
Detailed work by Monitor, the NHS economic regulator, has identified where other potential savings could be found. A mass selloff of unused property and land would net the NHS between £5bn and £7.5bn. Rationing A&E services could yield £4.7bn in efficiencies. Another £2.5bn might come from making GPs more efficient. However Monitor said last month that even in best-case scenarios the NHS would fall short of its saving target by about 8%.
Officials said the public will have to shoulder greater responsibility for their wellbeing – citing those with long-term conditions such as diabetes, depression, dementia and high blood pressure.
Analysts say the issue of closing hospitals and relocating care needs an "urgent debate". Chris Ham, chief executive of the King's Fund, said: "The government's recent NHS reforms failed to address these challenges. This time politicians and policy-makers must deliver – this means having the courage to transform services, rather than making further bureaucratic and structural changes."
A DH spokesman said: "The NHS has always had to respond to patients' changing needs and expectations. As lifestyles, society, technology and medicine continue to change, the NHS needs to change also. However, NHS England are clear that this will not mean cutting, charging for or privatising services. And this does not change the fact that any changes to local services must have the support of GP commissioners, be backed by clear clinical evidence, involve local people and support patient choice.
"There must be a rigorous local assessment of any proposals to reconfigure clinical services against those tests. If proposals for change do not meet those tests, then those changes will not happen."
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