The great PFI swindle

In 2011, the independent researchers Jim and Margaret Cuthbert showed the
scale of the returns to investors when they analysed three hospital contracts
for Hereford Hospital, the Edinburgh Royal Infirmary, and Hairmyres in East
Kilbride.2 Shareholders are predicted to make truly astronomical gains. Equity
of just £100 invested in rebuilding Hairmyres Hospital is projected to
earn £89 million in dividends over 30 years, while half a million pounds of
equity in the new Edinburgh Royal Infirmary is expected to win dividends
of £168m and a £1,000 equity in Hereford will yield £555.7m. These high
rewards are contractually protected and underwritten by government. The
Cuthberts’ analysis of internal financial projections for six PFI schemes show
investors are expecting to recoup 12 times more than they invested. The UK
Government has ignored these findings and there has been no major enquiry.

Using investors’ own projections, the Cuthberts calculated how much profit
was predicted from the six schemes and found that £42m of “subordinate debt”
invested by the companies building the six schemes was predicted to yield £517m. The profits on the £717,297 put in as equity by shareholders were projected to reach £350m.


NHS doctors’ open letter

After five years of a government which pledged to protect the NHS, this election campaign makes it timely to assess its stewardship, since 2010, of England’s most precious institution. Our verdict, as doctors working in and for the NHS, is that history will judge that this administration’s record is characterised by broken promises, reductions in necessary funding, and destructive legislation, which leaves health services weaker, more fragmented, and less able to perform their vital role than at any time in the NHS’s history.

In short, the coalition has failed to keep its NHS pledges.

The 2012 Health and Social Care Act is already leading to the rapid and unwanted expansion of the role of commercial companies in the NHS. Lansley’s Act is denationalising healthcare because the abolition of the duty to provide an NHS throughout England abdicates government responsibility for universal services to ad hoc bodies (such as clinical commissioning groups) and competitive markets controlled by private-sector-dominated quangos.

In particular, the squeeze on services is hitting patients. People may be unaware that under the coalition, dozens of Accident & Emergency departments and maternity units have been closed or earmarked for closure or downgrading. In addition, 51 NHS walk-in centres have been closed or downgraded in this time, and more than 60 ambulance stations have shut and more than 100 general practices are at risk of closure.

The core infrastructure of the NHS is also being eroded with the closure of hospitals and thousands of NHS beds since 2010.

Mental health and primary care are faring no better – with both in disarray due to funding cuts and multiple reorganisations driven by ideology, not what works. Public health has been wrenched out of the NHS, where it held the ring for coordinated and equitable services for so long.

In September 2014, the Royal College of General Practitioners said that the wait to see a GP is a “national crisis”.

In England the waiting list to see a specialist stands at 3 million people, and in December 2014 NHS England estimated that nearly 250,000 more patients were waiting for treatment across England who are not on the official waiting list.

Throughout England, patients have been left queueing in ambulances and NHS trusts have resorted to erecting tents in hospital car parks to deal with unmet need.

A&E target waiting times have not been met for a year, and are at the worst levels for more than a decade; and elderly, vulnerable patients are marooned in hospital because our colleagues in social care have no money or staff to provide much-needed services at home.

Funding reductions for local authorities (in some places reductions as high as 40%) have undermined the viability of many local authority social care services across England. This has resulted in more patients arriving at A&E and more patients trapped in hospital as the necessary social care support needed to ensure their safe discharge is no longer there.

The NHS is withering away, and if things carry on as they are then in future people will be denied care they once had under the NHS and have to pay more for health services. Privatisation not only threatens coordinated services but also jeopardises training of our future healthcare providers and medical research, particularly that of public health.

Given the obvious pressures on the NHS over the last five years, and growing public concern that health services now facing a very uncertain future, we are left with little doubt that the current government’s policies have undermined and weakened the NHS.

The way forward is clear: abolish all the damaging sections of the Health and Social Care Act 2012 that fragment care and push the NHS towards a market-driven, “out-for-tender” mentality where care is provided by the lowest bidder. Reversing this costly and inefficient market bureaucracy alone will save significant sums. Above all, the secretary of state’s duty to provide an NHS throughout England must be reinstated, as in Scotland and Wales.

As medical and public health professionals our primary concern is for all patients.

We invite voters to consider carefully how the NHS has fared over the last five years, and to use their vote to ensure that the NHS in England is reinstated.
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Tories’ deception: NHS massively underfunded

The doctors’ union points out that the Department of Health’s budget to fund health in England will only have gone up by £4.5bn by 2020-21 compared to the current financial year, well below the £10bn extra the government has pledged to increase it by. …

The BMA bases its claim on joint projections by the King’s Fund, Nuffield Trust and Health Foundation thinktanks. They found that Osborne’s spending reviewlast November means that the Department of Health’s budget will rise by just £4.5bn during this parliament – to £120.9bn by 2020 – but that NHS England’s share of it to pay for frontline services will go up by £7.6bn to £108.9bn. Continue reading

NHS underfunded

In 2000 the UK spent 6.3% of its GDP on health once public and private spending is added together (this is done to take into account the social insurance schemes that exist in some countries). Under Labour this rose and by 2009 it had hit 8.8%, which was above the EU average in 2000.

But the boom years had also prompted other nations to increase their spending so that by 2009 the EU average (for the 14 other members compared in 2000) was now 10.1%.

Of course since then the global economy has had to cope with turbulent times and so spending on health has stopped rising. In the rest of the EU it has remained pretty constant, while in Britain it has fallen Continue reading

This NHS crisis is political

Over 2015, the number of national newspaper headlines featuring “NHS” alongside the words bust, deficit, meltdown or financial crisis came to a grand total of 80. Call this the NHS panic index – a measure of public anxiety over the viability of our health service. Using a database of all national newspapers, our librarians added up the number of such headlines for each year. The index shows that panic over the sustainability of our healthcare isn’t just on the rise ­– it has begun to soar.

During the whole of 2009, just two pieces appeared warning of financial crisis in the NHS. By 2012 that had nudged up a bit, to 12. Then came liftoff: the bust headlines more than doubled to 30 in 2013, before nearly tripling to 82 in 2014. Newspapers such as this one now regularly carry warnings that our entire system of healthcare could go bankrupt – unless, that is, radical change ­are made. For David Prior, the then chair of the health watchdog the Care Quality Commission – and now health minister, that means giving more of the system to private companies. Continue reading