In this context
savings are cuts to services, and
efficiency (sometimes referred to as
sustainability) is about reducing services to match insufficient funding.
Service cuts can be obvious when a service closes, or less obvious for example, when staff are forced to work under worse terms and conditions. The drive for
efficiency savings began in earnest in the 1980s under the Thatcher government, and accelerated during the 1990s after the introduction of the NHS and Community Care Act . Following the 2012 Health and Social Care Act , which gave away day-to-day control of the NHS to NHS England , unprecedented underfunding (see Big Picture - NHS Funding ) coupled with plans to put Accountable Care Organisations in control of regional services, has dovetailed with cuts and closures to hospitals, GPs and other services, taking place at a speed never seen before in the history of the NHS.
Mergers are often a precursor to service closures.
What is happening in South Tyneside has been seen many times elsewhere:
As far back as 1996, a then recently merged health authority - Merton, Sutton and Wandsworth - ran out of money to fund the Queen Mary general hospital at Roehampton. Over the preceding 10 years there had been several smaller hospital closures in that area, but this was the first acute hospital threatened. Management consultants were called in to help with the adverse publicity, and to present the decision to close the hospital as technically neutral. The hospital provided training for paediatric junior doctors. That training was scrapped with the consequence that 24-hour children's services were no longer viable. This had a domino effect leading to the undermining and closure of other specialities and finally the viability of the whole hospital. Members of the public felt they had to bow to the inevitable, and were never given the real reasons that led to their local hospitals and services being closed, namely the high cost of introducing market mechanisms imposed by the NHS and Community Care Act.
Hospital service reconfigurations are predicated upon cost saving schemes, which typically include reducing non-elective (emergency and urgent referrals) services, as well as cutting general A&E attendances, outpatient appointments, and even elective (waiting list) operations. In short
efficiency savings are weasel-words for a planned reduction in the availability of services.
Many reconfigurations revolve around the closure or downgrading of an A&E, even though A&E services represent only a very small share of NHS spending. However, closing A&E services if often the first step to downgrading and closing hospitals.
Almost every closure of an acute hospital since the 1980s has begun with the closure of A&E services. It marks the start of a tried and tested sequence of events, and in itself creates a phony 'clinical' justification for the continued process of downgrading and closing more services and finally the whole hospital. The key elements that make a general hospital are gradually removed, as these services support other services, those other services will be pronounced 'unsafe' and removed. It becomes harder to recruit medical staff, and this too becomes a justification for further cuts.
Hardly any of the community-based settings (alternatives to hospital) actually exist. There are no staff, no premises, no plans, no money and no political will to establish these services. If attempted, alternatives to hospital care can easily turn out to be more expensive (See Integrated Care ).
As services are centralised, the issue of whole populations facing longer journeys for treatment (or to visit people in hospital) is ignored. The management consultants and senior NHS managers who draw up these plans most likely don't use the NHS, but if they do they certainly have comfortable cars and plenty of money.
In 2014 the NHS Confederation produced a document (written by spin-doctors) to help Clinical Commissioning Groups push through these plans against widespread public objection. As with the Path to Excellence , the proposals use a language which might fool someone who hears only the reassuring words, but does not understand the implications of what is being suggested.