Health crisis, what crisis?

The health service in Wiltshire is in an unprecedented crisis. Five out of seven community hospitals are under threat of closure, and now the PFI Great Western Hospital in Swindon has announced job cuts.

No wonder Patricia Hewitt was booed by nurses at the RCN conference. To assert that this has been “the best year ever” for the NHS contradicts the reality experienced by staff and patients, and the mounting number of redundancies around the country. What appears incomprehensible to many is why this crisis is taking place when the government is spending more money than ever before on the NHS. Where is the money going? Some of it has gone to increased wages for NHS staff (historically many of them lowly paid), but most of that has gone to the new consultants’ contract, and to GPs. Still more is being handed over to private companies as a result of the introduction by this government of a ‘competitive market’. In fact they are throwing money at the private sector. Far from open competition, PCTs have been instructed to hand over work to the private sector. The government has introduced a ‘payments by results’ system for the NHS, but the private companies have been guaranteed payment whether or not they do the amount of work they are contracted to do.
So whilst hospitals around the country are making cuts in service because they do not have sufficient funds to carry out all the work that they could, private companies are being paid for work which they have not done. In furtherance of their free market ideology the government is giving privileges to big business. This is a system which will necessarily eat away at the very foundations of the NHS because, under ‘payment b y results’, the less work the NHS does then the less money it receives. This is not a ‘free market’ but a system which the government has rigged in favour of private business. In fact in order to encourage the private sector to enter into the ‘health market’ the government is actually paying an average of 11% more per operation to private companies than it pays the NHS!What has precipitated the rush of thousands of redundancies around the country is the instruction from the government that all Trusts have to balance their books. The NHS is to operate like a profit-making business. But, of course, it is not making things, but treating people who do not fall sick by order. As one health worker said to me, what happens if the budget has run out and there is a smash on the motorway? Do they turn the patients away? Send them to another hospital? The answer, of course, is that they would make cuts elsewhere.

These reforms supposedly to improve ‘efficiency’. But since the government has decided that the NHS must operate like a business, the measure of efficiency comes down to the ‘bottom line’. It is budget driven. Under the old system if a hospital over-spent as a result of an increase in numbers of people they treated, a situation beyond its control, the additional money necessary was provided.

In Wiltshire the crisis is unprecedented.

• The Great Western Hospital in Swindon is proposing 99 redundancies and a further 99 posts to be frozen.
• In the area of the Kennett and North Wilts PCT, it is proposed to close 5 community hospitals. Depending on which option is chosen, Melksham and Savernake hospitals could be closed, leaving just Chippenham hospital open.
• Malmesbury Community hospital’s maternity and minor injuries unit has already been closed by Kennet & North Wilts PCT.
• In January debts were announced of £8.2 million for Kennet & North Wilts, £3.7 million for South Wiltshire PCT, £1.7 million for Swindon & Marlborough Trust, and £7.5 million for West Wiltshire PCT.

As a result of the financial crisis of the PCT’s, the Intermediate Treatment Centre at the Great Western Hospital has 36 out of 108 beds unused (20 of these beds are in any case already already for private work) because of drops in ‘demand’ from surrounding PCTs. The purpose of building the ICT was to take pressure off of the beds in the GWH. Chief Executive Lyn Hill-Tout has now come up with the brilliant idea of leasing more space to the private sector!

The redundancies proposed for the Great Western are designed to save £2.2 million a year. But they are not “efficiency savings”. In a paper presented to the Trust Board on April 28th the management admit the cuts “will lead to reduced staff for patient care”. Moreover, although they are asking for volunteers for redundancy they will have discretion over who is given redundancy, depending on how much each individual would receive (length of service etc). So whether there are sufficient volunteers remains to be seen. Either way the loss of jobs will impact on the service provided. The Trust has merely said it will try to ‘mitigate’ the impact.

The Swindon Advertiser editorial described this situation as “yet more evidence of the shameful and chronic shortfall in funding it must perennially suffer.” From this it draws the conclusion that:

“The fact that the money should come from Whitehall is something that the hospital, like the rest of Swindon will just have to live with.”

On the contrary, given that this is just the beginning of the crisis, instead of such a ‘nothing can be done’ attitude, it is necessary to campaign for a fundamental change of direction from the ‘health market’ that the government is introducing.

When the NHS was founded in 1948 it was a decision to take health care out of the market; to turn it into a social service rather than a commodity which people had to buy or go without if they could not afford to pay. Health care was considered as something which was a social right irrespective of the economic circumstances of each individual.

Whilst the current government says that it will continue with health care free at the point of delivery, they have undermined the rationale for a free service (actually based on general taxation). It has introduced a system in which Trusts compete with each other for patients. ‘Patient choice’ treats patients as if they were ‘consumers’ paying for a commodity. In reality patients do not want a choice when they are sick. They would like to be treated at the local hospital, or the nearest one which dealt with their particular illness if it was a specialised discipline. They do not want to have to drive a long way because their local hospital has been closed.

To preserve what is best about the NHS there is an urgent need for a campaign to reverse the ‘reforms’ which the government has introduced; end the ‘health market’ and competition for patients.

Nationally the Keep Our NHS Public ( campaign has been launched to oppose the government’s reforms. It brings together NHS staff and their trades unions, patients and supporters of the NHS. The latest support came recently when the Junior Doctors’ conference within the BMA voted to support the campaign.

There is some interest expressed amongst NHS staff for setting up a local group of KONP. If anybody is interested in helping out please contact Swindon TUC ( ) or ring 07786 394593.

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