NHS financial squeeze is a contrived crisis

Mike Marqusee says the problems at Barts health trust are caused by attempts to make impossible levels of cuts – while handing billions to private firms

July 30, 2013
6 min read


Mike MarquseeMike 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.

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 MarquseeMike 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.


✹ Try our new pay-as-you-feel subscription — you choose how much to pay.

Greenwald speaks Trump, War on Terror, and citizen activism
Glenn Greenwald was interviewed by Amandla Thomas-Johnson over the phone from Brazil. Here is what he had to say on the War on Terror, Trump, and the 'special relationship'

Pass the domestic violence bill
Emma Snaith reports on the significance of the new anti-domestic violence bill

Report from the second Citizen’s Assembly of Podemos
Sol Trumbo Vila says the mandate from the Podemos Assembly is to go forwards in unity and with humility

Protect our public lands
Last summer Indigenous people travelled thousands of miles around the USA to tell their stories and build a movement. Julie Maldonado reports

From the frontlines
Red Pepper’s new race editor, Ashish Ghadiali, introduces a new space for black and minority progressive voices

How can we make the left sexy?
Jenny Nelson reports on a session at The World Transformed

In pictures: designing for change
Sana Iqbal, the designer behind the identity of The World Transformed festival and the accompanying cover of Red Pepper, talks about the importance of good design

Angry about the #MuslimBan? Here are 5 things to do
As well as protesting against Trump we have a lot of work to get on with here in the UK. Here's a list started by Platform

Who owns our land?
Guy Shrubsole gives some tips for finding out

Don’t delay – ditch coal
Take action this month with the Coal Action Network. By Anne Harris

Utopia: Work less play more
A shorter working week would benefit everyone, writes Madeleine Ellis-Petersen

Mum’s Colombian mine protest comes to London
Anne Harris reports on one woman’s fight against a multinational coal giant

Bike courier Maggie Dewhurst takes on the gig economy… and wins
We spoke to Mags about why she’s ‘biting the hand that feeds her’

Utopia: Daring to dream
Imagining a better world is the first step towards creating one. Ruth Potts introduces our special utopian issue

A better Brexit
The left should not tail-end the establishment Bremoaners, argues Michael Calderbank

News from movements around the world
Compiled by James O’Nions

Podemos: In the Name of the People
'The emergence as a potential party of government is testament both to the richness of Spanish radical culture and the inventiveness of activists such as Errejón' - Jacob Mukherjee reviews Errejón and Mouffe's latest release

Survival Shake! – creative ways to resist the system
Social justice campaigner Sakina Sheikh describes a project to embolden young people through the arts

‘We don’t want to be an afterthought’: inside Momentum Kids
If Momentum is going to meet the challenge of being fully inclusive, a space must be provided for parents, mothers, carers, grandparents and children, write Jessie Hoskin and Natasha Josette

The Kurdish revolution – a report from Rojava
Peter Loo is supporting revolutionary social change in Northern Syria.

How to make your own media
Lorna Stephenson and Adam Cantwell-Corn on running a local media co-op

Book Review: The EU: an Obituary
Tim Holmes takes a look at John Gillingham's polemical history of the EU

Book Review: The End of Jewish Modernity
Author Daniel Lazar reviews Enzo Traverso's The End of Jewish Modernity

Lesbians and Gays Support the Migrants
Ida-Sofie Picard introduces Lesbians and Gays Support the Migrants – as told to Jenny Nelson

Book review: Angry White People: Coming Face to Face With the British Far-Right
Hilary Aked gets close up with the British far right in Hsiao-Hung Pai's latest release

University should not be a debt factory
Sheldon Ridley spoke to students taking part in their first national demonstration.

Book Review: The Day the Music Died – a Memoir
Sheila Rowbotham reviews the memoirs of BBC director and producer, Tony Garnett.

Power Games: A Political History
Malcolm Maclean reviews Jules Boykoff's Power Games: A Political History

Book Review: Sex, Needs and Queer Culture: from liberation to the post-gay
Aiming to re-evaluate the radicalism and efficacy of queer counterculture and rebellion - April Park takes us through David Alderson's new work.

A book review every day until Christmas at Red Pepper
Red Pepper will be publishing a new book review each day until Christmas


137