There could not be a clearer signal that the ultimate goal of this Tory government (forget the Coalition myth) is the full-scale commercialisation of all Britain’s public services than the latest plan to bring in the credit-rating agencies to monitor and control NHS hospitals. This is taking the country back to pre-1948 when finance, not health, ruled the roost. Monitor, the NHS regulator, is replacing assessment based on clinical quality with a purely financial regime, calling in the credit-rating agencies to assess the financial strength of hospitals. For the first time for 70 years the key requirement will not be whether the hospital is delivering high-quality healthcare to those who need it, but simply whether it’s safely making a profit. There are several reasons why this is profoundly wrong.
First, whilst of course financial viability has to be secured in all organisations, the prime purpose of a hospital is to restore ill people to health, one of the most fundamental of human needs, and a civilised society will ensure that that takes precedence both in terms of the allocation of national budgets and of individual treatment being optimised irrespective of income. The credit-rating plan will reverse this priority, even to the point of forcing hospital trusts or private companies that fail to get ‘investment grade’ ratings to cease to operate.
Second, even in terms of their narrow remit to judge financial strength, credit-rating agencies have an appalling record. The provided triple A rating to many financial derivatives during the 2000s which caused the global crash when it turned out they were next to worthless. The US Financial Crisis Inquiry Commission concluded that the 3 big credit-rating agencies (Standard & Poor’s, Moody’s, and Fitch) “key enablers of the financial meltdown”.
Third, many of the hospitals currently in financial difficulties are not badly managed but rather saddled, through no fault of their own, with enormous PFI liabilities that were forced on them against their will. The credit-rating plan will mean that, not only is public expenditure for those hospitals top-sliced to give priority to paying off PFI debts to private consortia, but the range and quality of healthcare provided will be significantly diminished to fit with whatever funding is left over.
Fourth, and most profoundly of all, the fundamental values on which British society has been built since the Second World War are being overturned. The IDS so-called Welfare Reform bill will put a funding cap on the abolition of poverty, the Gove proposals for ‘free schools’ and academies aim to make education a profit-yielding enterprise, social housing is being all but squeezed out, and now NHS hospitals will be subjected to the unalloyed dictates of the financial market.