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.
Billions, banks and bailouts
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.
Cause and effect
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
Mike Marqusee 1953–2015, wrote a regular column for Red Pepper, 'Contending for the Living', and authored a number of books on the politics of culture, on topics ranging from cricket to Bob Dylan.