Get Red Pepper's email newsletter. Enter your email address to receive our latest articles, updates and news.
The financial crisis threatening jobs and services at Britain’s biggest NHS hospital trust, Barts in London, is a scandal and a tragedy – because it is entirely contrived.
According to trust executives, among the main causes of the putative £2 million per week shortfall is the ‘non-delivery of planned cost improvement programme schemes.’ In other words, the trust has been unable to implement the spending cuts it had undertaken to make as part of the four year NHS-wide £20 billion ‘efficiency savings’ programme.
It’s not that the trust hasn’t been trying to meet its ‘savings’ targets or that staff have been wanton with resources; it’s that those targets cannot be met without compromising patient care. It’s a paper exercise largely detached from the realities of service provision.
In its report on the Barts crisis, the Guardian notes that ‘Attempts to cut wage costs are failing because vacancies are having to be filled by agency staff.’ What could better illustrate the irrationality of the NHS financial squeeze? Patient needs are non-negotiable; the demand does not fluctuate according to the economic cycle and therefore the supply has to be consistent and continuous. This cannot be done within the ‘business’ model embraced by the Barts bosses. (And the only serious error I’ve suffered in my own treatment at Barts was down to an agency nurse on a night shift who didn’t understand how to use a particular piece of equipment.)
The same point applies to the problem of escalating accident and emergency costs. The hospitals are pushing hard for people not to resort to A&E unless it’s absolutely necessary, but in the end A&E demand is out of the hands of the hospitals that have to meet it. Requiring an arbitrary level of savings from A&E is tantamount to requiring an arbitrary cap on A&E demand, which is not possible, unless you’re simply going to deny treatment to people who need it.
The Guardian article notes that the trust is avoiding mentioning the elephant in the room: the massive £1.1 billion PFI re-building programme – one of the biggest public-private partnerships in Europe – that costs the trust some hundred million pounds a year, 15 per cent of its annual income, in repayments. These, it appears, can never be renegotiated or re-scheduled.
Or not quite. The trust has recently announced that after intensive scrutiny of the books, it has clawed back some £7 million from the PFI consortium – over the 42 year life of the contact. By the end of that period repayments made by the trust on the original £1.1 billion will total £7.1 billion.
Construction giants Skanska and funders Innisfree are the main partners in the PFI consortium. But most of the original £1.1 billion comes from banks, including banks that have been bailed out by the taxpayer, or were in any case advancing the capital because a high rate of return was guaranteed by the taxpayer.
So the public sector releases money at low or no rates of interest to the private sector, which then lends it back at high rates to the public sector. And it’s not just Skanska and Innisfree that reap the rewards. The trust has multi-million contracts outsourcing services to a range of corporations: Health Care Projects (management services), Carillion plc (cleaning, catering and security), Siemens Medical Solutions (medical equipment) and Synergy Healthcare (sterile services). In recent years, Barts senior executives have regularly migrated into the upper echelons of companies doing business with Barts, notably HCP. And this is one reason why they won’t talk about that elephant in the room: not only the mighty, profit-churning PFI beast, but Barts’ increasing colonisation by and integration into a parasitical private sector.
Muddying the waters is the news that the Barts Trust hospitals are to face inspection as a result of ‘serious patient safety incidents … poor patient confidence and trust in its nurses; long waits for urgent cancer treatment; excessive rates of Caesarean section births; and too many emergency re-admissions.’ Redressing any of these shortcomings will require more, not less, money; and the proposed cuts in staff and departmental spending will surely exacerbate these and other existing problems.
But here’s where the current spate of negative stories about NHS treatment plays a dubious political role. Not because the stories are untrue or insignificant (they are neither), but because they are the effects, not the cause, of the NHS crisis.
My own care at Barts over the last six years has been superb. With a few exceptions, nurses, doctors, technicians and receptionists have been expert, efficient, caring, responsive. But it’s quite obviously a service under enormous and mounting pressures. I regularly attend the weekly haem-oncology clinic, which is always packed with patients. There’s usually a delay of 40 minutes or more between your appointment time and actually seeing a doctor. Patients accept this because when you do see a doctor, you get as much time and attention as is needed. I’ve never felt rushed or cut short; whatever issues I have at that moment are dealt with in full. This can sometimes take as much as an hour of the doctor’s time – which means people behind me in the queue wait longer. And of course the costs to the trust rise. So it’s not inefficiency but efficiency – if the measure is to be safe, effective patient care – that’s making Barts financially ‘unviable’.
Now there will be pressure on staff to process patients more quickly. At the same time, there will be fewer staff to deliver the service.
The trust says it wants to reduce ‘emergency re-admissions’; that will mean staff erring on the side of not re-admitting patients, and thus exercising less caution, less diligence, in ensuring necessary care is provided.
I hope staff at Barts resist this attack on their jobs and on the essential, life-sustaining services they provide. It’s often seemed to me that Barts survives on their good will alone. They’ve already been hammered by a steady fall in real wages and there is a sad fatalism among many, not helped by the patchiness of the union presence across the trust. What’s vital for them to understand is that what’s happening now is not about failings at Barts; it’s a manifestation of the general crisis in the NHS, a crisis brought about by cuts, fragmentation and privatisation, and one that can only be addressed through a mass movement that forces a radical redirection in government policy.
Mike Marqusee is a patient at Barts
The Spanish state is seizing ballot papers and raiding meetings, write Ignasi Bernat and David Whyte – but it is being met with united resistance
The crunch executive meeting ahead of Labour conference agreed some welcome changes, writes Michael Calderbank, but there is still much further to go
Dipesh Pandya speaks to documentary film-maker Sanjay Kak, who for 30 years has been working outside the mainstream to tell a story rooted in the struggles of those excluded by India’s militarism and its narrative of neoliberal growth
Jeremy Gilbert on how radical Labour politics can be inspired by the utopianism of the counterculture
Disasters have unequal impacts – it's the poor and marginalised who suffer most. David Harvey writes on Hurricane Harvey
Survivors of the fire are still relying on thousands of community volunteers, writes Dan Renwick - but the failed council is plotting a comeback
What if it's not us who are sick, asks Rod Tweedy, but a system at odds with who we are as social beings?
The people could reach a democratic and non-violent solution if they were freed from US meddling, argues Boaventura de Sousa Santos
A decade after the start of the crash, economic power is in our hands – we must take it, writes Ann Pettifor
Flooding the cradle of civilisation: A 12,000 year old town in Kurdistan battles for survival
It’s one of the oldest continually inhabited places on earth, but a new dam has put Hasankeyf under threat, write Eliza Egret and Tom Anderson
New model activism: Putting Labour in office and the people in power
Hilary Wainwright examines how the ‘new politics’ needs to be about both winning electoral power and building transformative power
What is ‘free movement plus’?
A new report proposes an approach that can push back against the tide of anti-immigrant sentiment. Luke Cooper explains
The World Transformed: Red Pepper’s pick of the festival
Red Pepper is proud to be part of organising The World Transformed, in Brighton from 23-26 September. Here are our highlights from the programme
Working class theatre: Save Our Steel takes the stage
A new play inspired by Port Talbot’s ‘Save Our Steel’ campaign asks questions about the working class leaders of today. Adam Johannes talks to co-director Rhiannon White about the project, the people and the politics behind it
The dawn of commons politics
As supporters of the new 'commons politics' win office in a variety of European cities, Stacco Troncoso and Ann Marie Utratel chart where this movement came from – and where it may be going
A very social economist
Hilary Wainwright says the ideas of Robin Murray, who died in June, offer a practical alternative to neoliberalism
Art the Arms Fair: making art not war
Amy Corcoran on organising artistic resistance to the weapons dealers’ London showcase
Beware the automated landlord
Tenants of the automated landlord are effectively paying two rents: one in money, the other in information for data harvesting, writes Desiree Fields
Black Journalism Fund – Open Editorial Meeting
3-5pm Saturday 23rd September at The World Transformed in Brighton
Immigration detention: How the government is breaking its own rules
Detention is being used to punish ex-prisoners all over again, writes Annahita Moradi
A better way to regenerate a community
Gilbert Jassey describes a pioneering project that is bringing migrants and local people together to repopulate a village in rural Spain
Fast food workers stand up for themselves and #McStrike – we’re loving it!
McDonald's workers are striking for the first time ever in Britain, reports Michael Calderbank
Two years of broken promises: how the UK has failed refugees
Stefan Schmid investigates the ways Syrian refugees have been treated since the media spotlight faded
West Papua’s silent genocide
The brutal occupation of West Papua is under-reported - but UK and US corporations are profiting from the violence, write Eliza Egret and Tom Anderson
Activate, the new ‘Tory Momentum’, is 100% astroturf
The Conservatives’ effort at a grassroots youth movement is embarrassingly inept, writes Samantha Stevens
Peer-to-peer production and the partner state
Michel Bauwens and Vasilis Kostakis argue that we need to move to a commons-centric society – with a state fit for the digital age
Imagining a future free of oppression
Writer, artist and organiser Ama Josephine Budge says holding on to our imagination of tomorrow helps create a different understanding today
The ‘alt-right’ is an unstable coalition – with one thing holding it together
Mike Isaacson argues that efforts to define the alt-right are in danger of missing its central component: eugenics
Fighting for Peace: the battles that inspired generations of anti-war campaigners
Now the threat of nuclear war looms nearer again, we share the experience of eighty-year-old activist Ernest Rodker, whose work is displayed at The Imperial War Museum. With Jane Shallice and Jenny Nelson he discussed a recent history of the anti-war movement.
Put public purpose at the heart of government
Victoria Chick stresses the need to restore the public good to economic decision-making
Don’t let the world’s biggest arms fair turn 20
Eliza Egret talks to activists involved in almost two decades of protest against London’s DSEI arms show
The new municipalism is part of a proud radical history
Molly Conisbee reflects on the history of citizens taking collective control of local services
With the rise of Corbyn, is there still a place for the Green Party?
Former Green principal speaker Derek Wall says the party may struggle in the battle for votes, but can still be important in the battle of ideas
Fearless Cities: the new urban movements
A wave of new municipalist movements has been experimenting with how to take – and transform – power in cities large and small. Bertie Russell and Oscar Reyes report on the growing success of radical urban politics around the world
A musical fightback against school arts cuts
Elliot Clay on why his new musical turns the spotlight on the damage austerity has done to arts education, through the story of one school band's battle
Neoliberalism: the break-up tour
Sarah Woods and Andrew Simms ask why, given the trail of destruction it has left, we are still dancing to the neoliberal tune
Cat Smith MP: ‘Jeremy Corbyn has authenticity. You can’t fake that’
Cat Smith, shadow minister for voter engagement and youth affairs and one of the original parliamentary backers of Corbyn’s leadership, speaks to Ashish Ghadiali
To stop the BBC interviewing climate deniers, we need to make climate change less boring
To stop cranks like Lord Lawson getting airtime, we need to provoke more interesting debates around climate change than whether it's real or not, writes Leo Barasi
Tory Glastonbury? Money can’t buy you cultural relevance
Adam Peggs on why the left has more fun