The announcement by the government that they are writing off £13.4 billion debt is welcome. However, this so-called debt is nothing other than the result of NHS Trusts doing ‘too much’ work. In other words it is the result of arbitrary targets set by government. NHS organisations cannot determine how much work they do like a company deciding how many cans of beans to make. They never know how many people are going to fall ill and walk (or be carried) through the door. How can they?
More important than the £13.4 billion is the albatross round the NHS’s neck, PFI debt. This is around £55 billion. Given the scale of the crisis and the extraordinary pressure on the NHS it would make sense to write this off. PFI was responsible for too small hospitals and too few staff. We knew this in Swindon before it opened and when it did, the full-up sign was posted within weeks of it opening.
Ever since the ‘internal market’ was introduced there has been pressure on the NHS to perform as if it was a business in the market place. However, in the market ‘efficiency’ is measured by the profit margin. It does not take account of the health or environmental impact. In healthcare, efficiency should be measured by health outcomes. A patient released from hospital too early (to save money and make way for another patient) is liable to cost the NHS more money than if they were released safely, because they are likely to be readmitted.
For many years now we have known that there was insufficient spare bed capacity. Even in normal times they are usually 90% full. The winter crisis was extended to virtually the whole year. There were barely more than 4,000 ICU beds, hence the desperate scramble to increase their number by up to seven fold.
One of the reasons why so-called bed blocking happens is because of the insufficient resources in the care sector. There has been much talk of combining the care sector with the NHS. This can’t happen without care homes and domiciliary care being a public service. It should not be dominated by profit-making companies with a super exploited workforce. There are insufficient staff and the time they have with the people they visit is too short.
The coronavirus crisis has emphasised the fact that many of the key workers on whom our lives and our more general health depend are low paid and exploited. This must change.
On the other hand, speculators who make money from money and make bets on market failure fulfil a socially useless function which, when it blows up can ruin the lives of millions. Their speculation should be taxed out of existence.
The NHS must be relaunched as a public service, publicly funded and publicly provided. It should not be an arena for rich pickings for private companies whose rationale is to maximise their profits. Profit is literally a waste of money since it is taken out of the NHS and stuffed into the pockets of shareholders instead of being ploughed back into the service.
One final point. It is an utter disgrace that the government has allowed front line staff to risk their lives by working without the full PPE that they should be wearing. This, and the criminal policy of “herd immunity” are responsible for needless deaths. There will have to be a reckoning over this. We must never again allow the NHS to have too little capacity and too few resources to deal with a crisis like this.
This is published in today’s Swindon Advertiser under a different heading. I’ll post the link when it’s on-line.