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Our NHS job cuts probe exposes myth that only ‘bureaucrats’ will go

Having spent most of last week furiously denying False Economy’s NHS job cuts figures, the government has finally conceded that the number of clinical jobs in the health service could fall.

In the end it took a Dimbleby to beat it out of them.

Andrew Lansley: The number of nurses and midwives has gone up since this coalition government came in. The number of doctors has gone up.

Jonathan Dimbleby: And do you expect the total to go on rising?

AL: No I don’t.

JD: You don’t expect it to fall? Or do you expect it to fall as well?

AL: I hope, if we get it right, we will be able to be sure that we reduce the bureaucracy and the staff in the bureaucracy, and that we focus on clinical jobs. But I cannot, as a consequence of the financial pressures we face, promise that we will keep exactly the same number of clinical jobs.

So, having spent most of last week furiously denying False Economy’s NHS job cuts figures, the government has finally conceded that the number of clinical jobs in the health service could fall.

But despite the Health Secretary’s reluctant admission on BBC Radio 4’s Any Questions last Friday, the government is still adamant that our report that more than 50,000 NHS posts are under threat – based on figures sent to us by NHS trusts themselves – was ‘scaremongering’.

Well, we can certainly admit one thing – when we said that just over 53,150 NHS posts were under threat, we were wrong. Since we published our figures, more trusts have responded to our Freedom of Information request:

So even though Epsom and St Helier University Hospitals NHS Trust came back reporting a small net increase in staffing, since we published our figures early last week the number of expected NHS job cuts has risen. So much for scaremongering.

As we have always made clear, most of the cuts will be through ‘natural wastage’ (freezing vacancies or redeploying staff) rather than redundancies. The government has made great play of this fact in an attempt to defend itself over the cuts. But natural wastage still means lost NHS posts. Patients who must wait longer for treatment because nursing posts have been cut won’t much care whether those nurses retired or were made redundant – their treatment is delayed either way.

The government’s other tactic is to challenge the accuracy of our figures. Conservative Deputy Chairman Michael Fallon and Welsh Secretary Cheryl Gillan have focused on University Hospital of North Staffordshire NHS Trust.

We reported – based on the Trust’s response to our FOI request – that North Staffordshire Hospital estimated a reduction of around 1,350 full-time posts from 2011-15. Both the government and the trust’s management now claim that these posts will be transferred to community healthcare, and will remain within the NHS.

But the FOI request we sent the trust specifically asked whether any given increase or reduction in staff numbers was the result of staff being transferred to or from other NHS trusts. We asked this precisely so we could discount these numbers from our total. But North Staffordshire Hospital made no mention of staff transfers within the NHS anywhere in its response. If there is any inaccuracy, it is the Trust’s, not ours.

Ministers also picked out Countess of Chester Hospital, whose chief executive has denied our figures – despite the Trust itself sending us those very figures on 11 February. Judge for yourself.

But what makes Countess of Chester interesting is that it gives the lie to the third part of Government evasion – the idea that these cuts can be made entirely by reducing ‘bureaucracy’.

Under Countess of Chester’s current plans, almost three quarters of management posts will go by 2015. More than a third of admin and estates posts will also be axed. The scale of these cuts to management and non-clinical posts is huge by anyone’s standards.

But even after these massive cuts to management, the Trust still forecasts a 12 per cent reduction in nursing, midwifery and health visitor posts. So even a hospital that cuts out three quarters of its management expects to lose more than one in ten of its midwives, nurses and health visitors.

It’s simple – these cuts cannot be achieved just by stripping out management. Frontline staff will go.

That said, we should spare some choice words for the massive non-clinical job cuts that are on the way. Non-clinical staff keep the NHS engine running so that clinicians can focus on the wheel. Take away the accountants, and doctors will have to run the accounts. Remove the cleaners, and nurses will end up cleaning. Cut the receptionists and drag in the midwives to staff the reception.

The real cause of bureaucracy and administration in the NHS is two-fold – top-down restructurings, and pro-market policies. Successive governments of all hues have regularly meddled in the NHS in order to crowbar so-called ‘private sector principles’ into the health service, trying to bring ‘efficiencies’ or fabricate a market where one wasn’t wanted. PFI, the provider-commissioner split, practice-based commissioning have all fuelled NHS bureaucracy down the years.

The administration required to oversee these policies cannot be removed unless these policies are reversed – but instead, the coalition government is embarking on the biggest top-down restructuring in the NHS’s history, precisely to turn it into a fully-fledged market.

Meanwhile, the impact of government funding cuts on frontline patient care is already being felt:

Ministers claim that the NHS funding shortfall and job cuts won’t damage frontline care, but this is precisely what is already happening.

Perhaps the other Dimbleby might care to beat it out of them.

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