The countdown to May 7 promises to be both tough and tedious for the NHS. Tough because no health system in the world has managed five years of little or no real growth without hitting a wall and, although the NHS has done remarkably well in the circumstances, it’s now really struggling to meet patients’ needs as well as performance targets. Tough also because the government, the department of health and NHS England are very adept centralising praise and devolving blame. Bullying and fear get passed down the NHS from the top, and those managers who fail to hit their targets are given brutal dressings down, and some are sacked.
In a snappy publication called ‘Operational resilience and capacity planning for 2104/15’, NHS England, Monitor, the Trust Development Authority and Adass (the association of directors of adult social services in England) give the absurd order that ‘there can be no trade-off between finance and performance’ in the NHS and social care system. If money must not affect performance, why has the department of health bunged £700 million to emergency departments where waits for admissions are rising sharply? For all the catch-up funding Labour ploughed into the NHS, we still spend less of our GDP on health care than most comparable countries, and you get what you pay for. A lot of needs are currently unmet, particularly for those with mental illness.
The election run-in will inevitably be tedious as Hunt and Burnham relentlessly dispute each other’s data and track records. Instead of a biased bullfight, the NHS needs political parties and the best brains to collaborate to figure out how to fund the care for people living longer, and with more – and more complex and expensive – diseases. The NHS is not a drag on the economy – it stimulates economic growth by employing 1.4 million people and keeping millions more healthy enough to work. But it needs to do far more to promote health, self-care and self-responsibility rather than just treating illness. Prevention is often better than cure. Rather than arresting drunks in casualty, the government needs to stop the sale of cheap alcohol and set a minimum price per unit.
The debate about whether the NHS is being privatised thanks to the Health and Social Care Act will be stoked by Burnham but it was Labour who opened the NHS up to the market and signed off PFI deals for hospital construction that were predicted at the time to be disastrous value for the NHS, and have crippled many hospitals now. For example, in the North East, the build cost for PFI hospitals was £812 million, but total repayment costs by the NHS will be £5512 million. In the North West, the build cost £1345 million, but the total repayment costs will be £10,325 million. Some hospitals are repaying over ten times the build cost. Gordon Brown’s Treasury signed these deals off as good value for money.
Even allowing for maintenance and running costs, these mark ups would amaze any loan shark. In most cases, the NHS won’t even own the buildings even if it does manage to pay back the outrageous loans. In Paul Foot’s PFI Special Report (2004), he quoted he Labour frontbencher Sam Galbraith nailing its attraction to the Treasury in 1996: ‘The Private Finance Initiative is basically about government bodies borrowing money but not having to set it against the public sector borrowing requirement. Today the private sector will only get involved in the PFI within the health services if it carries no real risk. The result is a financial sleight of hand, a massaging of figures as a result of which the increase in the public sector borrowing requirement is not shown and this is a matter of deceit.’
Paul Foot’s report may be a decade old, but it remains a very powerful contribution and warning of the dangers of private profiteering in the public sector, the debts that result from poor value deals, and the reckless stupidity of politicians who are still trying to keep PFI alive with PF2. Instead, the government should buy back these debts and renegotiate the deals for an amount that represents fair value to the NHS and the taxpayer. But the whole idea of PFI was to keep NHS debt off the balance sheet, and no government is brave enough to buy it back. Instead, trusts crippled with PFI payments are told ‘there can be no trade-off between finance and performance.’ PFI…. Paying For it Indefinitely