Tag Archives: Nhs

The fantasy of Osborne’s deficit cuts

The gap between Osborne’s swaggering rhetoric in his conference speech and the cold reality of the Tory public borrowing figures is almost unbridgeable.   The key point, though you would never guess it from Osborne’s bluster, is that public borrowing under his stewardship is now rising, not falling.   The ONS Public Sector Finances report for August 2014 show that the deficit (public sector net borrowing) from April-August this year was £45.4bn, an increase of £2.6bn compared with the same period for last year.   This 6% rise in public borrowing so far in this financial year could push the deficit, which last year was £99bn, up to around £105bn this year.   Moreover there are good grounds for expecting this trend of rising deficits to continue in future years.
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Almost total tack of accountability of private hospitals is a glaring scandal

Last month’s report by the Centre for Health and the Public Interest on patient safety risks in private hospitals is a real eye-opener.   Apparently more than 800 people have died ‘unexpectedly’ in private hospitals in the last 4 years, and a total of 921 serious injuries were recorded.   Even this may be a significant under-estimation since private hospitals are still not required to make data on hospital deaths and safety incidents publicly available.   The majority of private hospitals have no intensive care beds.   Some have no dedicated resuscitation teams, and surgeons and anaesthetists usually work in isolation.   There is often very little experienced cover at night, and typically there is one very junior doctor covering an entire hospital.   There are also gaps in after-care if things go wrong.

The NHS is increasingly being used as a support service for the private hospital sector.   More than a quarter of the sector’s income now comes from treating NHS-funded patients, and the NHS regularly serves as a ‘safety net’.   Thousands of people are regularly transferred to the NHS after treatment in private hospitals, with more than 2,600 emergency NHS admissions from the private sector in 2012-3.   Outrageously the NHS is not reimbursed for this, even if the emergency care follows a failure by a private hospital.
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If a referendum works in Scotland, why doesn’t Labour pledge a referendum on a fully public NHS?

Whoever wins on 18 September, the old order of the Tory-dominated Westminster establishment is finished.   If the Yes vote wins, it will have enormous negative repercussions for the London-based power structure and will spark huge and largely irresistible demands for real devolution of power for Wales and Northern Ireland as well as the metropolitan city regions in England.   If the No vote wins, the constitutional package now being offered to the Scottish people goes a long way to promoting a federal structure.   Gordon Brown on behalf of Coming Together is already advocating in his 12-point plan something akin to Home Rule.
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Leaks show US multinationals now directing doctors’ commissioning groups

Evidence has now been leaked which proves that big healthcare corporations, including some of the biggest US healthcare multinationals, are now taking the lead in directing GPs’ clinical commissioning groups (CCGs) in allocating the £80bn NHS budget at their disposal.   The previously unknown Commissioning Support Industry Group (CSIG) has been seeking to win contracts worth some £1bn for advising CCGs on purchasing patient care.   Those awarded these contracts will be involved in drug purchasing, negotiating hospital contracts, outsourcing services to the private sector, and (ominously) patient care reforms.  The leaks show that United Health, the huge US health insurer which significantly previously employed Simon Stevens, now NHS England’s chief executive and formerly of Blair’s office, actually chairs this group, provides its secretariat, and recently covered the funding for senior UK health managers to visit its care centres in the US and to “explore their applicability in the UK”.
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Under marketisation NHS managers get £1.6bn redundancy payments, care workers get 25% cut in pay

The market degrades all decent human instincts of fairness and concern for others.   Two events in the last few weeks dramatically expose how far this corruption of the values of the health service and social care has now gone.   One was the publication of the latest Department of Health accounts which shows payouts to some 4,000 ‘revolving door’ managers who have left since May 2010 with large payouts, only to return either on full-time or part-time contracts.   Altogether there have been over 38,000 redundancy packages awarded to managers costing a total of £1.6bn.   Since 2010 there have been 1,700 payouts to managers of £100-150,000, nearly 600 of between c£150-200,000, and 370 of over £200,000.   For comparison, in the last year before the 2010 election total redundancy payments amounted to just £35m.
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How long can the NHS go on like this?

The number of NHS trusts referred to the Department of Health because of financial irregularities has increased almost 4-fold in 2013-4 compared to the previous year.   The Audit Commission has just reported that 19 trusts, about 1 in 5,were flagged as financially failing.   Similarly 24 clincial commissioning groups, about 1 in 9, were also referred to the Secretary of State mainly because of ‘issues with their financial position’.   The same trend of deepening financial problems was reported by auditors over a quarter of trusts in the previous financial year, but by 2013-14 this group had risen to a third.   The trusts are caught in a vice between having to make unprecedented cuts of £20bn within the current 5-year parliamentary period, whilst having at the same time to meet enormous extra financial pressures from rising demand for healthcare services, the health needs of an ageing population, the above-inflation pressures from the ever-rising costs of the most advanced new technology, and the ever-stronger focus on the quality of care.

Research by the King’s Fund shows that this year 1 in 4 finance directors at NHS trusts expect ot overspend their budget.   The list includes some of the trusts that have been outsourced to corporate partners, notably the private Circle Health Care which for the last 2 years has operated Hinchingbroke Health Care in Cambridge.   Other well-known trusts include University Hospital of North Staffordshire, Barnet and Chase Farm Hospitals, and Ipswich Hospital.   This is a totally unsustainable situation.   The NHS is heading ineluctably towards collapse.   One can only speculate what is the objective of this most ideologically-driven Conservative government.   Do they intend to drive the NHS into such a financial collapse that large parts of it can swallowed up by private sector corporates for a song?   Is this slow but relentless drift to collapse politically feasible when A&E departments are becoming more and more overloaded, waiting periods are growing inexorably, GPs are becoming seriously overstretched, and public sector pay for nurses, porters and ancillary staff is being ruthlessly held down year after year?

Then there is underpinning all this the really big issue that healthcare costs always have, and continue to, exceed the rate of inflation by a significant margin each year for both demographic and technological reasons.   The Health Department’s own accounts reveal that health spending rose last year by 2.6% above inflation, which is actually a much faster rate than the two previous years.   And the Health Foudantion charity has pointed out that staff costs have increased significantly as hospitals responded to the Francis report on the Mid Staffordshire debacle by recruiting more doctors, nurses and other front-line staff.   They conclude that it’s difficult to see how the NHS can end 2014-5 without another significant increase in the pay bill.

This process of collapse is heading for an explosion before long.

 

Why does Labour stick to Tory austerity cuts when latest ONS figures show it’s impossible to achieve them?

Osborne’s boast that he would shrink the welfare state to its small scale in 1948 has been definitively scuppered by a report from the Office of National Statistics (ONS).    These official figures reveal that there are at least 6 major areas of public expenditure which are currently escalating rapidly and make it impossible to reconcile with his proposed 35% cuts in all non-protected Departments and a further £25bn cuts in benefits in the next Parliament.    This is reinforced by the latest news that the deficit (public sector net borrowing), the reduction of which is the ostensibly central objective of Osborne’s economic strategic, actually increased last year by £13bn despite a year of economic growth, whilst in the first quarter alone of the new fiscal year ONS figures now reveal a big increase in Tory government borrowing to £36bn, a worrying 7.3% increase over the same quarter in 2013.   This major reversal, if it continues as it shows every sign of doing so, leaves Osborne’s counter-productive deficit-reduction plan in tatters.
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The mentally ill are neglected in the NHS, but actively tormented by the DWP

As happens in all authoritarian organisations, the truth is so dreadful that it begins to seep out through leaks, secret briefings, off-the-record briefings that turn out to be recorded, and by other risky but well-intentioned means.   It has long happened in the case of disabled resisters determined to fight back against grotesque misjudgements by Atos over work capability assessments.   It is now just beginning to happen in the case of the mentally ill who are often even less able to protect their rights.   What is now being exposed is even worse than people’s wildest suspicions, exacerbated by the revelation that such bullying and aggressive treatment is deliberate DWP policy.
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If both Bank of England & IMF now calling for greater equality, why isn’t Labour making more of it?

It is remarkable that Mark Carney in his ‘Inclusive Capitalism’ speech of 27 May remarked that all the research shows that “relative equality is good for growth”.   It is not an original idea since Christine Lagarde, as well as the Pope, have both made similar comments.   So if even the Right from both the BoE and the IMF acknowledge that gross inequality has gone far too far and that the market system determining the allocation of pay is now wholly out of control, why doesn’t the Labour party run with it and make it one of the key half dozen themes at the National Policy Forum next Friday?   For the evidence of the toxic and damaging effects of the ultra-inequality we have today is overwhelming.

Contrary to New Labour’s attitude of “being intensely relaxed about people becoming filthy rich” on the grounds that it didn’t harm anyone else, all the evidence now indicates it does do exactly that.   There are now over 200 studies on income inequality and health.   Life expectancy, infant death rates, low birth weight, obesity, abd poor mental health have been repeatedly been shown to be worse in more unequal societies.   The UK, for example, has the 4th lowest life expectancy out of the 23 most developed countries.   The 3 countries with even lower life expectancy – Portugal, the US and Singapore – have even greater income inequality.
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