After three years of brutal Tory cash limits had brought mounting chaos to the NHS, Gordon Brown eventually relented in his March 2000 budget, and came forward with substantial new money. NHS spending as a share of Britain’s GDP is set to rise by almost 2 percent by 2004 - a £13 billion a year increase on 1999.
But this boost to spending was delayed so long that much of the new money in the first year has been swallowed up in covering debts and bailing out the NHS across the current winter period.
Many health authorities are already looking to stand still or cut services next year, and even those with more than enough money are struggling to find staff they can recruit to enable services to expand.
This is a useful reminder that even the extra cash, belatedly paid out, is by no means a guarantee of New Labour’s commitment to a public sector health service.
Instead, the controversial NHS Plan drawn up during the summer by Health Secretary Alan Milburn showed Blair’s Labour government eagerly shovelling billions from the NHS into the coffers of the private sector, while morale among health workers hits rock bottom.
Labour backbenchers and Commons Health Committee chair David Hinchcliff have become increasingly uneasy over the way the extra NHS cash is being spent, and the de facto privatisation of buildings and areas of care.
A new raft of 16 hospital building schemes to be paid for through the Tories’ Private Finance Initiative (PFI) will push the total value of hospitals to be rented by the NHS to a staggering £3.9 billion, with more still to come. Milburn has now approved bids for another 29 new hospital projects, worth another £3 billion.
PFI deals lumber local NHS Trusts with an obligation to pay hefty rents and service charges - guaranteeing profits to the private sector - for the next 30 years, while liquidating existing NHS land and property assets.
This bonanza for private sector profiteers follows hard on the heels of Milburn’s controversial "Concordat" with the private medical industry: NHS Trusts which run out of beds to treat waiting list patients will now be expected to fork out the cash to send them for treatment in nearby private hospitals. (Obviously this policy will predominantly apply to the South East, where most private hospitals are.)
This will certainly put a smile on the cheeks of Britain’s desperately unpopular and struggling private sector. Even after 21 years of Thatcherite policies have squeezed the NHS and forced up waiting lists, most private hospitals have been jogging along barely half full, for lack of sufficient rich and stupid patients: Milburn’s cash injection is just what they wanted.
No estimates have been published on how much this half-baked scheme could cost the NHS, but there is no doubt that it is a sure-fire "lose-lose" situation for hard-pressed hospital chiefs.
Not only will the Trusts under the greatest pressure be obliged to find cash from their budgets to line the pockets of the private operators, but they will also see vital staff lured away from front-line jobs in the NHS to do the work.
Milburn even boasted that "the doctors will be NHS doctors, and by and large the nurses will be NHS nurses."
They certainly will: the private sector trains no staff at all, but never scruples to poach nursing and medical staff trained by and for the NHS.
Another aspect of the "Concordat" is supposed to be increased use of private nursing homes for older patients, to relieve pressure on NHS beds across the winter period.
Unfortunately for Milburn this coincides with the first signs of a substantial run-down in nursing home places, as profit-hungry proprietors shut up shop, arguing that they are not paid enough by social services and health authorities. The result is likely to be more hospital beds "blocked", and more queues on trolleys.
As the winter begins, a BBC survey has found that around a third of NHS Trusts are expecting to cut or cancel waiting list treatment. Unusually, this time around the main problem is not money, but problems spending the £630m allocated to "winter pressures" after Gordon Brown’s budget.
More staff are needed, but pitiful rates of pay have made it increasingly difficult to recruit more nurses. A miserable 3.7 percent pay offer for most nurses and professional staff in 2001, just half a percentage point above inflation, coupled with a similar miserly deal for most lower-paid NHS support staff, seems to underline the government’s refusal to confront the growing problems of attracting and retaining suitable workers to keep services running.
Tony Blair’s latest cheapskate wheeze - a revamped NHS nurse "bank", and the promise of subsidised housing or a feeble £600 a year hand-out for most ordinary nurses in London and high-cost areas - will be seen as a patronising irrelevance by NHS nurses. They don’t want tied cottages: they just want a wage big enough to live on! But the insult is even greater for ambulance crews and tens of thousands of other health workers, who don’t even get the token £600.
We say that PFI schemes should be scrapped at once, and some of Gordon Brown’s unspent surplus should be made available as a new pool of NHS capital for a redevelopment of hospitals, mental health and community services - as assets for health care in the future.
Existing PFI hospitals must be nationalised and reintegrated with the NHS, along with all of the privatised domestic, laundry, catering and other services, which have been handed over to contractors.
Means-testing for care of the elderly should also be scrapped, and private nursing home chains run by major corporations should be nationalised. Large local nursing homes should also be taken over by the NHS, which, working with local councils - should take back the responsibility for the financing and provision of long-term care for the frail elderly - free at point of use and funded from taxation. Where necessary the NHS should build or remodel existing buildings to create additional nursing home accommodation.
The continued "purchaser-provider split" which lives on in the NHS should also be swept away (as Labour is planning to do in Scotland) with the abolition of NHS Trusts. Instead elected health authorities should be established, which would plan and manage services in each area, in conjunction with health workers and representatives of local patients and the wider local community.
The NHS must use its power as a monopoly purchaser to force down the prices of vital drugs and other supplies, coupled with the imposition of a turnover tax on the sales of pharmaceuticals by multinational firms and the nationalisation of those which refuse to comply.