We are entering (in case you hadn’t realised it) a general election campaign. As far as the NHS is concerned it is going to be the bitterest and most tragic election campaign ever. This is the first time the NHS is being argued over without consideration of any underlying principles of any kind. At the last election the pattern was set for the future by the naked lie about not seeking any major reform. The promises offered by David Cameron in 2010 about the NHS built upon valued principles but have proved to be as shallow, short term and shabby as the failure to mention planned reform. Now it is only about money.
No-one can deny that there should be budgets and management should pay full regard to its financial obligations. But this is a public service and should be run for the benefit of the public. The balance has been twisted by short-term thinking about the politics of deficit. This has twisted almost every area of public life. Lets look at some problems in the NHS and think how politicians with a proper public interest might act.
We find that the financial deficit in about half of all Foundation Trusts is less than what they collectively spend on agency staff, mostly nurses. They need the nurses to meet their performance and safety targets. One of the problems with nurses is that they have not had a real pay review for some years so leaving and joining an agency, or going abroad, is an attractive route forward. Somewhere or other in all this there is an answer based on sensible principles which respects nurses, patients and budgets.
Another big issue is so-called bed blocking. Once upon a time local authorities ran care homes. That was stopped and it was left to market forces to provide care for the elderly. There is no centralised view of care needs, that’s left to the market. At any one time this winter there have been thousands of NHS beds occupied by people who should be in a more appropriate care environment but there are not enough care beds available. This is market failure and the public is paying through the NHS. One answer is to increase the number of publicly funded care places so that the winter peak can be handled. Blindingly obvious. The principle should be that discharge into a non-hospital place must be guaranteed at the time it is needed. Why cannot hospitals invest in care units part-funded through care charges.
The bean counters had a field day with PFI. The idea was simple. We need new hospitals so get the private sector to build them and run the buildings while the NHS occupies them and runs the healthcare service, paying a service charges for the privilege of doing so. It moved hospital construction off the government’s balance sheet and piled it onto the NHS’s annual budget. NHS hospitals now owe £80bn in PFI loan unitary charges – in other words, the ongoing costs of maintaining PFI hospitals and paying back the capital (on a formula which benefits the PFI ‘partner’). More than one NHS Trust is paying 15% of its annual budget in such charges – that’s 15% of its budget which is ring-fenced, immune from cuts or economies. PFI needs re-negotiating, if necessary through legislation.
That’s three areas where the politicians and the NHS need to do some re-thinking. Its not about a couple of hundred million here or there to massage public opinion, probably funded through some poorly identified saving which has knock on side-effects no-one has spotted yet. All these are big areas where public service core principles should apply. However no-one is bothered about core principles, they are all looking for where a pound spent can be paid for by a pound saved and, most importantly, a headline won.
Look after the principles and the pounds will appear in the system. Fail to do so and the NHS will fail.