NHS faces huge challenge in meeting £1.5bn cuts in region

Patients will see the NHS radically re-shaped, with fewer services in hospitals and more care provided at home or in GP surgeries and the community.

But the task of meeting a £1.5bn efficiency challenge estimated to be facing the NHS in Yorkshire by 2015 is immense.

In the past five years, NHS spending has grown by 7.5 per cent annually – although only roughly 35p in every pound has been spent on new services as the rest is swallowed by inflation in wages, drug costs and technology. Public spending cuts will mean increases of only 2.5 per cent each year in future.

The issue is additionally complicated as the savings must be delivered at the same time as Government plans for the biggest-ever NHS reorganisation, which today reach a key landmark as GPs in half the region take control of the bulk of budgets for the first time.

Under the savings plan, more than £1bn in efficiencies in Yorkshire must be delivered by hospitals, mental health services and other providers of care.

Some – likely to involve downgrading or even axing key hospitals services – will cause huge controversy. Others, such as increasing use of the latest telemedicine technology to help people with long-term ailments to stay at home or greater use of day surgery, will deliver improvements in care.

Target plans show the biggest efficiencies will be needed in the East Riding and Hull. But largely-rural North Yorkshire could be faced with the hardest task as it struggles to overcome decade-long financial problems.

One key focus involves reducing hospital admissions which it is claimed will fall overall by 2015 in Doncaster, northern Lincolnshire, North Yorkshire, Leeds and Sheffield. Numbers of unplanned hospital visits will be cut by more than 10 per cent in Rotherham, while in North East Lincolnshire there are ambitious plans to reduce avoidable emergency hospital admissions by as much as half.

Ron Calvert, chief executive at the Doncaster and Bassetlaw hospitals trust, said he believed the NHS was “more than capable” of rising to the challenge.

One key aim in reducing hospital admissions lay in creating an “integrated care” approach by stepping in early to help patients who might otherwise seek hospital treatment. By improving the quality of care for people with long-term chronic conditions – among them the lung complaint COPD, asthma and angina – it could also ultimately reduce costs.

“If you can support people in their own home, instead of requiring a hospital admission four, five or six times a year sometimes for weeks at a time, you can often confine them to one or fewer a year,” he said.

Improvements in telehealth meant patients’ vital signs could be monitored remotely but it was also about encouraging patients and families to be better informed so they knew how to respond to problems.

He added: “It becomes a virtuous rather than a vicious circle because the more you pre-empt and manage patients in a less expensive setting, the greater the chances of dealing with an increase in demand.”

Among doctors taking a lead role in commissioning care is Ferrybridge GP Phil Earnshaw, who is set to head a group covering more than 300,000 patients in the Wakefield area.

He believed patients would get a better experience of NHS care with greater involvement from GPs. “We hear in our surgeries every day about what does work and what doesn’t. As GPs we will be trying to make these systems work much better for patients and more coherent in providing care from the beginning to the end.”

The aim would be to use efficiencies to innovate to provide new ways of providing services.

Recent investment in diagnostic facilities in the Wakefield district meant more tests could be carried out in the community but many patients still turned to hospitals for urgent care.

“From a commissioner point of view that means resources can be sucked in and it gives you very little spare to innovate and to change the way things are done,” he said. “We as GPs have a responsibility to change that around.”

He accepted that by taking on new roles, GPs would have to be mindful of spending but they were in any case constrained by resources.

“As GPs we are going to have to learn to be more open with patients on what basis any decision is made, particularly if finances do deteriorate,” he said. “We need care to be as good quality and accessible and efficient as possible and by doing that we will deliver long-term savings.”

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