In the current issue of the trade union
UNISON's journal (UNISON Summer 2006) Gordon Brown claims that by 2007
investment in the National Health Service will almost have tripled since Labour
was elected in 1997. What a lovely Labour government we've got!
So readers will no doubt be puzzled by the
constant news stories that the NHS is facing a funding crisis, that NHS trusts in
the country have deficits of £512 millions, and that they may have to lay off
doctors and nurses as a result.
Is Gordon Brown lying? No, he's not. So
what is happening? A great deal of the money being pumped into the NHS is
coming straight out the other side into the pockets of private capitalists
without even touching the sides of the health service. We pay taxes for the
NHS, not to subsidise parasites!
This is happening because New Labour is
determined to commercialise the NHS. And it's not working. Their failure is
costing us a packet. Specifically three policies are bleeding the NHS of the
money being pumped in:
- The Private Finance Initiative
- Reintroducing an internal market into the health service
- Fees for management consultants.
PFI
Socialist Appeal has dealt with PFI before.
This brainwave comes from the Tories. Instead of the government borrowing money
and building, staffing and opening a hospital, a private consortium borrows
money and owns and runs the hospital. What is the point of this? According to
Treasury rules (which are unique to Britain), private borrowing doesn't
count as public debt. So it doesn't exist – it's off the balance sheet and
therefore invisible. Public sector finances look better as a result. This is
plain daft. In either case money has been borrowed and a hospital built. So
what's the difference? Why should the provision of public services be hampered
in this way? If the Treasury has mad rules, why doesn't Gordon Brown just
change them?
Actually there is a difference between
public provision and PFI. The government can borrow money at lower interest
rates because it's never going to go bust. Lending to the government is risk
free. You'll always get your money back in the end. Not so with a private
consortium. So it's going to cost more for the PFI people to borrow -10%
interest rates instead of 4-5%. They don't bother about that, because they hand
us the bill. In the end we pay the extra through our taxes.
There's another difference. A private
consortium is involved in the health service only because it wants to make
money. That profit will in the end come from our taxes. Where else can it
possibly come from? Nice one!
PFI is risk free and very profitable. The
Association of Chartered Certified Accountants reckons that early PFI hospital
schemes between 2001 and 2002 paid out returns in excess of 100%. Nice ‘work'
if you can get it! In economic theory returns of that order are a ‘reward' for
risk. It is quite obvious that if a PFI hospital scheme went belly up in a
large town, the government would have to step in and rescue it. You can't have
a big town without a hospital. So there is no risk for the consortium. The only
people taking risks are us letting these cowboys in on our health service. When
the health trusts that actually hand out the money to the private consortia get
into financial difficulties, guess what comes first? It's paying for PFI. So
doctors and nurses get the chop.
The internal market
The second source for the leak of NHS
funding is the reintroduction of the internal market. Another Tory wheeze, this
was abolished in the first years of the Labour government. Unfortunately a
stake was not driven through its heart and it's back.
Tony Benn often says that ‘the NHS is the
most popular thing we (Labour) have ever done and the most socialist.' The
underlying principle of the service is universal free provision on the basis of
need, pure communism. No longer true. Those of a Tory disposition have always
been irked by our communist health service and hankered after creating a market
in health provision. The idea is absurd. How can anyone make money out of the chronically
ill, the mentally ill or the unconscious patients being rushed to casualty? How
can these people in these positions really exercise ‘choice' in any meaningful
way? Does the patient really understand what's best for their health? If so,
why have health professionals at all?
New Labour is again following in the
footsteps of the Tories, insisting there should be choice between providers,
including a private capitalist option. This introduces competition which, as
all capitalist apologists think, leads to higher efficiency.
Actually this competition is far from a
level playing field.
It is true that some operations are now
routine and treatment is like an assembly line in some respects. An example is
operations to treat eye cataracts. Private clinics can do this sort of routine
work, and private capitalists can make money out of the process. If anything
complicated comes up, of course, they'll chuck the patient back on to the NHS. The
government has allocated £5 billion to dish out to private clinics. Private
clinics are actually subsidised to take patients away from NHS hospitals and have
been allowed to charge more for the same operations. They are also guaranteed a
certain number of operations to keep their beds busy. So public resources we've
all paid to build up lie underused, and the hospital trusts declare deficits. The House of Commons Select Committee on
Health looked at private clinics, found no efficiency gain and concluded that
the policy would, "destabilise local NHS trusts, especially those with
financial deficits."
Patients are not interested in choice –
they are interested in getting the best treatment available. This is not some
arcane Marxist dogma. It is universally known by health professionals and
anyone else with their head screwed on. The only people who don't understand
this are New Labour ministers. The real result of attempting to introduce a
market into the NHS (actually a pseudo-market) is to drain the service of front
line resources.
Management consultants
The third set of leeches on our health
service are the legions of consultants introduced into the NHS and the rest of
the public sector by New Labour since 1997, once again following on from the
Tories. The basic dogma in the government's head is ‘public sector bad, private
sector good.' They have a saucer-eyed infatuation with capitalism as they
conceive it. And consultants come from the private sector, so they must be
possessed of some entrepreneurial flair not held by those backward enough to
work in the public sector and stupid enough to believe in public service.
Consultants do have flair, particularly when it comes to padding out their
expenses. But they have no relevant expertise to offer the public sector.
The world of management and IT systems
consultancy is unveiled by insider David Craig in a book called Plundering the public sector: how New Labour
are letting consultants run off with £70 billion of our money (Constable,
2006).
"We can take somebody straight off the
street, teach them a few simple tricks in a couple of hours and easily charge
them to our clients for more than £7,000 per week, while we probably pay them
around £700 per week," he reveals.
Consultants
will swan in to a government department and advise on railway signalling. On
the next assignment they'll tell the Inland Revenue how to collect Value Added
Tax. Moving on to the Child Support Agency or the Passport Office, they have
cut a swathe of destruction through the public sector with their ‘expert' and
expensive advice.
If you want to introduce a new IT system
somewhere, they probably know less about the technology than the people already
there. They'll certainly know less than the workers about what is needed to
improve the service. They won't consult the workforce. They'll put together a
package and they'll take their cut. It's quite a nice cut. They're basically
sales reps and it's in their interests to sell you the biggest and most
expensive package. They've cost the NHS £10 billion so far. That's £10 billion
not being spent on doctors and nurses.
The consultants have planned their biggest
heist ever. It's the gigantic IT project for the NHS called Connecting for
Health (CfH). Its main feature is a plan to computerise all patient records. CfH
is likely to cost £35,000 per health worker. The government is to stump up £6.5
billion, but health authorities will probably have to put another £25-30
billion to make the local connections.
When we recall that all the big IT projects
recommended by management consultants for the public sector have come in years
late and massively over budget, that's enough to make the blood run cold. The
signs are not good. Routinely we get reports (for instance London Metro
story August 1st) that the system has crashed. The Observer (6th August) reveals
that a report was sent anonymously to the Public Accounts Committee that the
project is not going to work. As usual, ministers are trying to hush the story
up. After all Health Minister Patricia Hewitt knows the score. She used to work
for Anderson Consulting, an arm of the crooked accountants caught up to their
necks in the Enron fraud.
How much this might end up costing us is
shown by a part of the CfH programme already implemented called Choose and Book. This programme was to
cost £65 million. This money only needed to be spent because of the internal
market reintroduced into the NHS. The idea was to computerise all the beds out
there and all the people waiting for operations so that these people could have
the widest ‘choice' as to where to have the op and book the bed online.
David Craig does the sums, in the process
making the same points as we did earlier: most people don't want ‘choice', they
want a decent service. Outside the big cities a choice of hospitals is utterly
impossible in any case. He works out that of 23.3 million people targeted by Choose and Book, only 5.64 million could
conceivably have any use for the system.
Guess what? Scheduled to cost £65 million, Choose and Book has set us back over
£200 million so far.
The NHS is being taken to the cleaners. The
commercialisation of the health service is a catastrophe. How far the
government would like to go is shown by the revelation that the government had
put an advert in the Official Journal of the EC inviting tenders from private
bidders for 80% of the NHS budget. Hewitt said it was all just a mistake. One
thing's for sure. We can't trust these people.
New Labour's policies for the health
service are ruinous and insane. The NHS is not safe in their hands, any more
than it was with the Tories. We need to reclaim the Labour Party, the party
that set up the NHS, in order to provide a decent health service for all.
