NHS plan: more money for NHS … and more for PFI
The government's ambitious multi-billion pound NHS Plan, announced at the end of July, is a vital attempt by New Labour to stem the tide of disaffection and demoralisation among its core supporters.
Opinion polls indicated that - three years after Blair was elected proclaiming that Britain had "ten days to save the NHS" - anger at the continued decline in health services was a central issue in the minds of the thousands of Labour voters who have failed to turn out in recent local and European elections.
Gordon Brown had to deliver big bucks if the government was even to appear as serious about tackling the chronic underfunding of the most popular and universal of the public services.
A big increase in NHS spending could also wrong-foot the Tories and leave them with little more to say than call for more people to take up private medical insurance.
Brown duly came up with mega-bucks for the NHS in his March Budget, pledging the largest and fastest increase in spending in the history of the NHS.
BUT LITTLE of the new money has yet been released into the system, and the lion's share of the first year's cash injection was held back for four months while Health Secretary Alan Milburn went through the motions of drawing up a "Plan", much of which could easily have been sketched out on the back of a fag packet within days of Labour taking office.
The added complexity of the Plan, above and beyond the basic decision to increase funding, beds and staff stems from New Labour's ideological determination to step up the level of the private sector's involvement in what will remain a tax-funded service.
Those Labour supporters who warmed to Tony Blair's robust old-Labour sounding rejection of private insurance and charges for treatment will be less than enchanted to discover that the NHS Plan will leave the service dependent on renting a massive œ7 billion worth of hospitals, clinics and health centres from the private sector, and buying an increasing amount of care from private sector nursing homes and private hospitals.
But the Plan is very much a curate's egg, in which good parts and sound proposals sit alongside irrelevancies, an extravagant expansion of the range of quangos, a refusal to extend any genuine democratic control, and a drive towards privatisation.
Unions and campaigners have correctly welcomed the Plan's headline-grabbing pledges for:
7,000 extra beds in hospitals and intermediate care
7,500 more consultants
20,000 more nurses
6,500 more therapists
2,000 more GPs
A maximum wait of 48 hours for a GP appointment by 2004, and by 2005 a maximum 3 months wait for an outpatient appointment and six months for a hospital admission.
An end to charges for nursing care for elderly patients in nursing homes
335 extra mental health crisis response teams
There is extra money to clean up our hospitals after standards have been driven down by 15 years of competitive tendering, and a priority to supplying better food.
MANY OF these commitments echo demands raised for years by health workers and campaigners, who have consistently pointed to the under-funding of the NHS as the key cause of long delays in treatment.
They will, however, be impatient to see these changes delivered swiftly, after years of empty promises - including Gordon Brown's stupid and self-defeating smoke and mirrors claim of an "extra œ21 billion for health" back in 1997.
But ... there are four fundamental problems in the Plan which will raise doubts among many campaigners and health workers on whether it can achieve the bold objectives it sets out.
The first problem is that the big increase in funding may have come too late. The cash came after three years of the Labour government: three years in which Gordon Brown has hidden behind lying rhetoric while holding NHS spending to the impossibly tight limits set by the Tories, creating a massive squeeze on services and running up deficits in Trusts and health authorities.
By the time the first injection of œ600m was pumped in to a desperate NHS, it was almost all soaked up by existing debts and deficits, bringing little if any expansion in services. Waiting lists, too, have been inflated by the cash shortfall, making it harder to reduce them.
The remainder of the extra œ2 billion allocated to the NHS budget this year has been held up at national level, pending the publication of the NHS.
Meanwhile half the first year has gone by: and many Trusts and health authorities are already bracing themselves for a new winter crisis - realising that in many cases it is already too late to expand services to avert embarrassing shortages of beds and staff.
The second problem has similar roots: the long term squeeze on pay, the pressure on front-line staff and the public perception of the decline of the NHS have undermined the morale of NHS staff - and made it more difficult to recruit and retain the skilled workers required to deliver an expanded and improved service.
The recruitment problems are most acute in the big cities and "boom" areas where soaring property prices make it increasingly difficult for NHS staff to find an affordable place to live.
But with a large section of the existing NHS nursing and professional staff due to retire in the next few years, there are real problems of staffing hospitals and community services.
It is even harder to ensure that the promised expansion of Intensive Therapy Unit beds and other specialist services can be delivered.
But short-sighted limits on NHS pay, lagging far behind the private sector, also make it harder to recruit vital support staff, whose efforts keep hospitals running.
The third big problem is that the planned expansion of "acute" (short-stay) hospital beds - with an extra 2,000 promised by 2004 - is too little to compensate for the massive extent of the bed closures forced through by 21 years of Tory cash limits.
Indeed the "extra" beds promised in the Plan could easily be wiped out by the hefty reductions in front-line beds which are being imposed through PFI hospital schemes, despite the governments own Beds Review and clear evidence of the pressure on beds and the rising proportion of emergency medical admissions.
NONE OF the plans to divert a growing number of these medical admissions into "intermediate" care or support them with primary care has so far been proven to work, especially in parts of the country where nursing home places are scarce and levels of chronic ill-health are high among older people.
If the government gets this wrong, then the entire plan for reducing the waiting list will be thrown into chaos as front-line beds are swamped by emergencies during peak periods and elective treatment is cancelled.
The fourth problem is that the government's plans to expand the NHS also revolve around a major role for the private sector, which is expected to:
Finance, build and run the large majority of the 100 new hospitals planned by 2010, and help finance 500 new primary care centres
Provide a growing number of "intermediate" beds in nursing homes
Provide additional facilities and services to treat NHS patients in private hospitals
Continue to provide support services including cleaning and catering, both through PFI consortia and through contracts with NHS Trusts.
This growing involvement of private, profit-seeking firms in the delivery of NHS services carries substantial dangers.
PFI represents a high-cost, low-value means of financing new hospitals, costing more for fewer beds, and siphoning millions from the revenue budgets of NHS Trusts over the next 30 years.
With only two PFI hospitals having so far (recently) opened, the pressures these developments will put on the system have yet to be fully tested. The early indications are not good.
The private nursing home sector, which is expected to provide many of the promised "intermediate" beds, has for decades failed to invest in facilities in London and other key areas of the country, creating huge problems in the discharge of frail elderly patients from hospital.
Since the late 1980s the NHS has largely abdicated from any responsibility to provide long-term care for the elderly: it is not clear whether this can be reversed by the NHS Plan.
The government's response to the deplorable standards of hospital cleaning since much of it was privatised in the mid 1980s is not to bring the services in-house, but to hand over even more money to the same profiteering companies to clean up the mess they have made.
These four key problems seem certain to dominate the scene as ministers struggle to push through their Plan, hoping against hope for another mild winter, and that they have not left it too late to win back public confidence in time for the next Election.