Tories’ Own Auditor Finds “Financial Problems are Endemic and This is Not Sustainable” for NHS’s Survival | Andy Worthington (original) (raw)

Campaigners for the NHS with a banner featuring Nye Bevan's famous quote about the NHS. Photo by Andy Worthington, from 'Britain Needs A Pay Rise', a march and rally in London organised by the TUC on October 18, 2014.

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The NHS faces an unprecedented crisis, and it’s all the Tories’ fault (with the help of some senior NHS officials). A new report by the National Audit Office, the government’s official auditor, has found that “[t]wo-thirds of health trusts in England are now in deficit,” and “their total debt has almost trebled since 2015 to £2.45bn,” as the Guardian described it, adding that auditors “were particularly alarmed by the decision to transfer £950m [out of a total of £4.6bn] from the NHS’s budget for buildings and IT to pay staff’s wages.”

The report follows the revelation on Monday that, as the Guardian described it, “[c]ontroversial plans put forward as a way of improving the health service in England and ensuring its sustainability risk being used as a cover for cuts and running down the NHS,” as Dr. Mark Porter, the chair of the British Medical Association (BMA) council explained. The Guardian added that the BMA stated that the 44 regional Sustainability and Transformation Plans (STPs) put forward in September “amount to £22bn in cuts by 2020-21 to balance the books, which will have a severe impact on patient care” — an understatement if ever I heard one. The impact, if implemented, would be nothing short of disastrous.

Amyas Morse, head of the National Audit Office, stated that its report found that the NHS’s “financial problems are endemic,” and that this situation “is not sustainable” for a functioning health service. Her analysis of the crisis also included a recognition that “an increasing number of clinical commissioning groups (CCGs)” — the groups set up under the Tories’ complete (and manifesto promise-breaking) overhaul of the NHS — were “unable to keep their spending within budget.”

The Guardian pointed out that knowledgeable MPs have been saying that the report “amounts to one of the the most critical assessments of NHS finances by official auditors, as their reports usually err on the side of caution,” adding that it “will add to pressure on Theresa May and the chancellor, Philip Hammond, to set aside extra money in the autumn statement on Wednesday to plug the funding gap in the health service.”

Meg Hillier, the chair of the Public Accounts Committee, said in response to the report’s publication, “I call on the prime minister to address [in the autumn statement] the realities of increasing deficits in NHS trusts, long-term workforce problems, unrealistic efficiency targets and the impact these financial stresses are having on the quality of services.” She added that the Department of Health was making “pie in the sky assumptions” about closing the funding gap.

The National Audit Office also explained, as the Guardian put it, that the NHS “entered the current financial year with a ‘worse than expected starting point,’” and that this “could hamper plans to close the estimated £22bn gap between patients’ needs and resources by 2020/21” via the 44 regional Sustainability and Transformation Plans. The Guardian pointed out that the Department of Health, NHS England and NHS Improvement have estimated that “they can make £6.7bn of efficiency savings through measures including capping public sector pay and renegotiating contracts,” and that “trusts and CCGs can make a further £14.9bn of savings by ‘moderating the growth in demand for healthcare services’ and by making 2% productivity and efficiency improvements.”

However, this is rubbish, as the auditors realised, and as senior figures involved in healthcare have been aware of during the development of the STPs.

In September, Chris Ham, chief executive of the King’s Fund think tank, said, “There are concerns that some areas are focusing on plans to reorganise acute hospital services, despite evidence that major reconfigurations of hospital services rarely save money and do not necessarily improve care.” He added that “[p]lans in some STPs to reduce the number of hospital beds are also unlikely to succeed.”

Nigel Edwards, chief executive of the Nuffield Trust think tank, was even more critical. “I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap,” he said, adding, “One insider said to me: ‘Optimism bias abounds.’”

For their part, the National Audit Office, having examined the estimates for proposed savings, “warned they had not been properly tested,” and stated that this “raises concerns about whether planned savings can be achieved”. In addition, on the Department of Health’s £950m transfer from the capital project budget to cover staff wages, the NAO noted, “The department did not assess the long-term effects of transferring this funding to cover day-to-day spending. This means it does not know what risks trusts may face in future as a result of addressing immediate funding needs.”

A year ago, “amid mounting fears about the pressures” faced by the NHS, the Cameron/Osborne Tory government announced that front-line NHS services in England would “get a £3.8bn, above-inflation cash injection” in 2016, as the BBC put it, but the Guardian noted that “hospital executives said this week that the money was not enough.”

Chris Hopson, of NHS Providers, “said the settlement needed to be redrawn,” and Prof. Jane Dacre, president of the Royal College of Physicians, said that the NHS was not only “struggling to balance today’s books,” but was also “unable to invest in new plans,” in the _Guardian_’s words. As she said, “We need an NHS budget that meets the demand for health services now and in the future.”

The urgent need to defend the NHS, the UK’s greatest creation

Last November’s recognition by George Osborne that the NHS urgently needed more money was a sign of the urgency of the situation, as the Tories, in general, would like to starve the NHS of funds as much as possible to allow private healthcare providers to take over, thereby thoroughly destroying this county’s greatest creation. However, they are also aware that they cannot be seen to do so, or voters might rebel and destroy them instead.

My description of the NHS as this county’s greatest creation is not a casual one, and it is also one shared by millions of my fellow citizens. Crucially, the NHS is paid for by general taxation, on the basis of which everyone, from the richest to the poorest, is guaranteed free treatment when their lives are at risk, and is also guaranteed free treatment for other significant health issues. The NHS is generally described as “free at the point of entry,” which it is, but it is also “free at the point of exit.” Because all payment is made through taxation, at no point does anyone get asked for payment — or refused treatment if they can’t afford it, or given a bill that will take them years, or decades to pay off, or end up being made homeless if they can’t afford to keep up their repayments.

For the immeasurable peace of mind this gives to all British citizens, the only inconvenience is that those on the higher tax rates (40% and 45%) pay more through general taxation than those on the standard rate (20%), and those who are unemployed or retired pay nothing in taxation. The redistributive element annoys the rich and greedy, but, to be blunt, their selfish obsessions are detrimental for society as a whole.

The Tories, however, disagree — as do those MPs of other parties who have investments in private healthcare providers and who stand to make handsome personal profits the more the taxpayer-funded NHS is destroyed.

Unfortunately, the enemies are not just in Parliament (and, as ever, in parts of the media). As we learned during the successful 2012-13 campaign to save Lewisham Hospital, senior NHS management has also bought into the alleged “need” for huge savings to be made to the NHS — largely through hospital closures, and some idiotic and poorly-conceived notion that people can be trained not to be ill.

For Lewisham, the NHS managers’ long-standing desire has been to downgrade Lewisham Hospital so that it no longer has an A&E Department, which would mean that it could no longer have a maternity department, and this, in turn, would mean that the entire population of Lewisham — 270,000 and rising — would have no maternity services. Try replacing Lewisham with Brighton, Hull or Newcastle, whose populations are similar, and suggesting that they should have their A&E departments shut down, so that anyone with any kind of emergency or potential emergency — first-time mothers, for example — would have to be sent to another city. It’s a ludicrous proposal, and just because the distances are shorter in London doesn’t detract from the reality that any neighbouring boroughs are already struggling to cope wth the demands of they own populations, which, of course, also run into the hundreds of thousands.

As I stated repeatedly at the time of the Lewisham campaign, every borough in London needs its own fully-functioning hospital, whereas the plans for Lewisham would have meant that three London boroughs — Lewisham, Greenwich and Bexley — with a total population of 750,000 would have had only one A&E Department between them, in Woolwich.

Stop the cuts

In the end, the only viable solution for the NHS is for the £22bn efficiency plan to be halted until the NHS is at least able to function once more without being crippled by debts and shortfalls based on unattainable financial targets. At present, we have a ludicrous situation whereby billions of pounds of cuts are being made at the same time that billions of pounds are being put back into the NHS to stop its complete collapse — the kind of bureaucratic idiocy at which politicians and senior business managers excel.

And when the freeze on the £22bn cuts takes place, the only acceptable next step is for the NHS to be audited publicly and openly, and for those who are able to defend its importance honestly to be allowed to point out how much it costs run an adequately funded NHS and, as a result, how much we all will need to pay in increased taxes to ensure its survival.

I am sure that, if implemented honestly, this would be supported by a majority of the British people — although I should note that, when factoring in the demands placed on the NHS by an ever-aging population, I think it is only appropriate for wealthier retirees to accept that means testing should be introduced to assess their ability to continue paying for the NHS even in retirement if they are wealthy enough.

This, I know, is a radical proposal, as wealthier retirees vote in large numbers, and as a result politicians rarely propose anything that would challenge them. However, on this, as on the need for an open debate to secure the necessary funding for the NHS’s survival, I can see no other way forward that is viable.

In conclusion, I am also prepared to accept that, in the UK as it currently stands, my conclusions mean that, officially, I am in dreamland, because, to bring about the above, we would not only need to get rid of most of our current politicians (including the lying advocates of the campaign to leave the EU, who lied so scandalously about saving £350m a week to be spent on the NHS); we would also need to disable the monstrous biased media operations in this country that persistently seek to destroy public services for malignant ideological reasons.

But, really, what other choice do we have? Do nothing, and moan about irrelevant issues, or distract ourselves with nonsense as the Tories, corrupt Labour MPs, greedy corporations and the corporate media turn back the clock back to a time before the creation of the NHS? I think not. We need to fight. As Nye Bevan, founder of the NHS in the post-war Labour government said, the NHS “will last as long as there are folk left with the faith to fight for it.”

Note: The photo at the top of this article is from my second photo set on Flickr from the TUC-led ‘Britain Needs A Pay Rise’ protest on October 18, 2014. The first set is here. Where is the trade union movement’s mass mobilisation against Theresa May’s useless government, I wonder?

Andy Worthington is a freelance investigative journalist, activist, author, photographer, film-maker and singer-songwriter (the lead singer and main songwriter for the London-based band The Four Fathers, whose debut album ‘Love and War’ and EP ‘Fighting Injustice’ are available here to download or on CD via Bandcamp). He is the co-founder of the Close Guantánamo campaign (and the Countdown to Close Guantánamo initiative, launched in January 2016), the co-director of We Stand With Shaker, which called for the release from Guantánamo of Shaker Aamer, the last British resident in the prison (finally freed on October 30, 2015), and the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by the University of Chicago Press in the US, and available from Amazon, including a Kindle edition — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. He is also the co-director (with Polly Nash) of the documentary film, “Outside the Law: Stories from Guantánamo” (available on DVD here — or here for the US).

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