by Stan Crooke
According to the Guardian (23 January), Health Secretary Patricia Hewitt is to call for an end to the so-called “hand out culture” in the NHS, and to demand that financial management be given a greater importance than clinical objectives.
Hewitt claims that the heavy debts which many NHS trusts have built up are the result of inefficiency, backed up by the belief that the NHS would “bail out” any trusts whose debts had reached a critical mass. Denying that the NHS is in crisis, Hewitt wants to “prioritise financial management” as the supposed key to eliminating the trusts’ financial deficits.
Despite Hewitt’s denial, the crisis is there for all to see.
A survey carried out by the Health Service Journal found that 63% of acute hospital trusts have closed wards and cut expenditure, 25% have made staff redundant, 75% have frozen recruitment, and 26% are planning to withhold tax payments until the new financial year. Even so, 37% still expect to be in deficit.
A Royal College of Nursing survey published the same week found that the overall NHS deficit may be as high as £1.2 billions, and the number of posts axed as high as 4,000.
One in four NHS trusts forecast that they will be in deficit by the end of the current financial year. Hospitals built under the Private Finance Initiative are burdened with exorbitant repayment schedules. Medicines bought by the NHS are the most expensive in Europe, more costly by up to 20% than in other European countries.
The crisis in the NHS is the direct result of the biggest transformation it has undergone since it was set up in 1948. Pushing the Tories’ “reforms” into the shadows, successive Labour governments have worked resolutely to “open up” the NHS to the alleged benefits of private sector involvement.
While this has brought major profits for the private sector, it has reduced the NHS to chaos.
The elevation of accountancy over patient care has already taken place and has resulted in ward closures, delayed operations and job losses. At a national level, the penetration of the private sector into the NHS has resulted in a fragmentation of services which makes planning increasingly difficult, if not downright impossible.
The government has effectively created a vicious circle. Its opening-up of the NHS to venture capitalists has resulted in a worse service for patients (and worse working conditions for staff). The falling standards of service are then used as the pretext for a further round of market “reforms” and for greater involvement by the private sector.
“Patient choice” has (supposedly) been introduced by the government. (In fact, patients always had a right to choose where they wanted to get treated.) Patients can now choose from any of four local NHS trusts where to receive their treatment. Consequently, hospitals lose income if they do not “attract” enough “customers”.
Hospitals which fail to attract sufficient “custom”, or which spend more than the “norm” on operations, face a management takeover by the private sector. The government is already in negotiations with BMI Healthcare (the largest private hospital chain in the UK) about taking over the management of “failing” NHS hospitals.
The government is also expanding the network of privately run “Treatment Centres”. These are funded to carry out operations at a cost which is higher than if they were carried out by the NHS. They receive the funding even if they fail to carry out the contracted number of operations. Having cherry-picked the most profitable forms of treatment, they leave the “unprofitable” treatment to the NHS.
Primary Care Trusts (PCTs) now face privatisation as well. The government says PCTs can decide for themselves whether to continue to provide frontline care or to transfer service delivery to the private sector (a partial retreat).
The “Keep Our NHS Public” campaign sums up the current government-provoked crisis and its implications for patients:
“At the heart of the changes is the creation of a market that welcomes profit-driven international corporations who answer to shareholders, not patients. This market will compel hospitals and health professionals, who have traditionally co-operated to deliver healthcare, to compete with each other and with the private sector.”
“Far from supporting the NHS, the private sector is in competition with it, and is already draining away resources and staff. … (Government reforms) will undermine the choice that is most important to patients – access to comprehensive, trustworthy and local health services.”
• More: Keep Our NHS Public, c/o NHS Support Federation office, Community Base, 113 Queens Road, Brighton BN1 3XG.