When the going gets tough, New Labour goes private …
NHS Trust chiefs see stars as Milburn puts the boot in
The succession of top-level reports slamming standards of care in hospitals should sound new alarm bells over Labour’s future plans to extend privatisation in what is still the most popular of all public services.
Health Secretary Alan Milburn’s immediate reaction to the Audit Commission findings that trolley waits and delays are getting worse rather than better in hospital Accident & Emergency departments was to announce extra money – for buying operations from private hospitals!
Another £40m will be used to encourage Trusts to divert another 25,000 waiting list patients into the private sector – more than doubling the numbers from last year – while only £10m is to be used to speed up elective treatment in NHS hospitals.
The logical conclusion of this approach would be that our busy general hospitals would be increasingly reduced to geriatric units with an A&E department, and carrying out the more risky and expensive operations which the private sector refuses to take on – while the booming private medical industry fills its beds and its wallets at the taxpayers’ expense.
Milburn has gone further, and told the Commons health committee that he plans to "buy up" the entire capacity of some private hospitals for a few years, and "monopolise" them for NHS patients.
But such an expansion of private medical treatment also means poaching more staff from NHS hospitals, worsening their performance, and allowing more reports to contrast NHS standards unfavourably with those in private hospitals.
This is far from the first sign of Milburn’s growing attachment to the private sector as the solution for problems created by the chronic under-funding of the NHS by both Labour and Tory governments.
He is the architect of last autumn’s Concordat with the private sector, and he has floated the idea that private firms may run a new variety of "health factory" units, delivering day surgery and elective treatment to the NHS.
And amid the growing complaints both from social services directors and from hospitals struggling to discharge frail older patients from front-line hospital beds, Milburn’s response was to allocate an extra £300m over three years – to be spent buying nursing home care from the private sector.
Yet the overwhelming evidence suggests that the private sector is baling out of the nursing home market, which yields far smaller profits than converting their properties into luxury flats.
It is estimated that as many as 50,000 nursing and residential home places have vanished across the country since Labour took office – leaving a gaping hole where there should be a service for vulnerable older patients.
Social services are increasingly running out of money: indeed several, including Oxfordshire and Richmond in London, have already exhausted their budgets for nursing home placements and can take no new referrals until next April – leaving hospitals to carry the can through the busy winter months.
The system, created by the Tory "community care" reforms of the early 1990s was a shambles waiting to become a crisis: Milburn’s addiction to private sector solutions has left him and his ministers unable to do anything but blame local managers as the problems escalate.
He has claimed that the new wave of hospitals being built under the Private Finance Initiative would bring an increase of 3,000 acute beds. This follows a change of policy after the first wave of PFI hospitals, most of which led to massive reductions in acute bed numbers – and created an immediate crisis in local health services.
But so far the evidence is that PFI schemes in the pipeline at best represent a standstill on bed numbers. In several cases where increased numbers are claimed, this means replacing front-line acute beds (which handle emergencies and waiting list cases) with "intermediate" beds, which deliver a lower level of nursing care.
Milburn’s recent boasts that the NHS last year expanded bed numbers – by the princely total of 700 across the country – ring hollow in the context of the mounting problems in discharging older patients – and the shortages of nursing staff, without whom the beds cannot be used. Oxford’s Radcliffe Hospitals Trust alone reports up to 100 beds at a time in the busy John Radcliffe Hospital cannot be used for lack of nurses – making a nonsense of the government figures.
Largely because of the lack of beds and nursing staff, the John Radcliffe got no stars in the recently published league tables. The management are under the cosh to deliver a rapid improvement – while they grapple with an underlying £4m deficit and an exodus of nursing staff who cannot afford a place to live in Oxford’s sky-high property prices.
The extension of the "blame" culture which has done such damage to morale among school teachers, and the management of the NHS by a bewildering series of "targets", "league tables", "star systems", commissions and "task forces", further helps to destabilise the public sector – while delivering few, if any actual improvements in services.
Unveiling the star ratings for 173 acute hospital Trusts, Milburn again revealed the extent to which he is reviving the Tory call for "enterprise culture" among NHS managers.
The 12 worst performers are to be closely monitored by the NHS Modernisation Agency, with the threat that the Trusts’ top managers could face the sack if they do not show improvements within 3 months. But the 35 hospitals at the top of the league table are to be given freedom to pay out bonuses – and to set up spin-off companies, listed on the stock market, to develop and sell new technology for profit!
Worse, Milburn revealed that there were "no surprises" in the list of failing Trusts: in other words ministers and NHS chiefs have known for months that some hospitals were on the slide … and done nothing about it, other than prepare to pillory the management.
It is hard to avoid the conclusion that some Trusts are being set up to fail – such as the Epsom/St Helier Trust in south west London, which not only received no stars, but was recently slammed as the "worst Trust in the country" by the government’s inspectorate, the Commission for Health Improvement (CHI) The Trust is up to £5m in the red.
But as a new chief executive was wheeled in, and talk began about an ‘action plan’, it became obvious that there would be no extra money to sort out any of the problems identified by CHI. CHI inspectors condemn – and then just walk away!
Epsom/St Helier has pointed out that it needs an extra 80 beds to meet the targets of the NHS Plan and cope with winter pressures. It has the space, but not the staff or funding required.
Its neighbour Trust in SW London, St George’s, is in a similar situation, with waiting lists soaring, and a desperate need to open another 82 beds. But neither they, nor the local Merton Sutton and Wandsworth Health Authority has the cash required to sort things out. Demoralised managers and staff recognise that they are doomed to endure more attacks from ministers keen to show how tough they are.
As if all this wasn’t bad enough, Alan Milburn, in a speech to the Fabian Society, has now dropped a heavy hint that the most hated and destructive element of the Tory market reforms – the introduction of competition between rival NHS Trusts – may be on its way back, under the guise of expanding "patient choice".
One of the very few positive elements of Labour’s NHS reforms after 1997 was to scrap what it called the "internal market" – the costly and complex process of annual negotiation of contracts between health authorities and Trusts. In place of competition for patients and revenue, Trusts were obliged to cooperate with each other.
However the controversial split between "purchasers" and "providers" of health care was maintained, and it now seems that by seeking to use patient choice as another way to clobber failing Trusts, Milburn could be moving back to a revival of the bad old days of the Thatcherite reforms.
All the statistics are beginning to show that four years of Labour reforms have done little if anything to improve the NHS, while queues for treatment in A&E units are actually longer now than they were under John Major.
Instead of shouting at the staff and the managers who are trying to implement the half-baked system he put in place, Milburn should be rethinking his basic assumptions.
If the present course continues, we can expect the worst of all worlds: long waits, blocked beds and an accelerating exodus of key staff from the NHS, while private hospitals celebrate a profits bonanza.