Last Thursday Andrew Lansley tried to highlight the cost of PFI to the NHS and did so by listing 22 trusts which he said were claiming that their clinical and financial stability was undermined by their PFI deal.
When a Secretary of State for Health says that 22 hospital trusts are in danger, it is something to which the people who live in those areas have to pay attention. He is warning that the NHS services they depend on may become clinical unstable.
Today I would like to explore why Andrew Lansley made such an important statement. Tomorrow I will examine what the repercussions have been and why.
Interestingly, by Friday morning many commentators already had a powerful and cynical explanation that this warning about the clinical viability of 22 specific trusts has nothing to do with the NHS, and everything to do with a much wider political attack upon the last Labour Government and public expenditure.
Thus the aim of the attack is in the second paragraph where Andrew Lansley said:
“The truth is that some hospitals have been landed with PFI deals they simply cannot afford.
“Like the economy, Labour has brought some parts of the NHS to the brink of financial collapse.”
Mike Farrar, CEO of the NHS Confed, gave a measured response to this,
”We are pleased the Government has been up-front with the fact PFI is a problem for many hospitals. But PFI is not the principal cause of the NHS’s financial problems.
“Repayments on PFI debt are likely to be £1.5 billion this year yet by 2014-15 the NHS needs to find savings of £20 billion.
“To address this we need to start looking at the NHS’ big ticket costs such as how we deliver care and where. We need pragmatism and leadership to do this as it will involve some extremely difficult decisions. A political blame game is a waste of time.”
As a piece of simple politics – Labour overspent on the NHS and has brought it to the brink of collapse – this is distinctly odd since it gives the impression that the Conservative Party is against having the new hospitals and would solve this financial collapse by spending less. This is after all the solution to financial problems in every other domestic area of policy. The schools are facing financial collapse so we will take money away from them, from housing, universities etc., etc.
So as a political message complaining that the Labour party spent a lot on the NHS -when you are pledging to spend a bit more – just doesn’t fit with their wider narrative regarding public expenditure.
That wider narrative – one that has worked in every other policy area except the NHS – is that the Labour Government spent too much, and we will spend less. But in the NHS it would now appear that the Labour Party spent too much – and we will spend more.
The danger for the Conservative Government is that many of the public already believe that they are cutting the NHS and spending less – and last week’s message will confirm that belief. These people will believe that – as with every other area of public expenditure – the line that Labour spent too much is followed by the line that the Conservatives will therefore spend less, and it is that that will explain the coming financial crisis in the NHS.
So I am not sure this is the only political reason for last Thursday’s attack on the 22 hospitals’ clinical stability. I think Andrew Lansley has recognised that – on his watch – a number of NHS trusts are going to face a financial and clinical crisis.
It may be that he has been told that this may be just a matter of weeks away.
It may be that in the list of the hospitals below are trusts that he believes that over the next few months they will not be able to pay staff wages.
It may well be that he knows there are already detailed discussions going on in the DH to provide some of these hospitals with “bungs” to keep them going over the winter, and because he knows this is coming he wants to get his answer to why this is happening on his watch out into the public domain.
So in a few weeks time we might get to hear:
“It is not my fault that whilst I am Secretary of State some of the NHS trusts have fallen over – it was the fact that the previous Government built a new hospital that caused this crisis.”
The Daily Telegraph had a paragraph hinting at this,
“There is already evidence that waiting lists for non–urgent operations have begun to rise as hospitals delay treatment to save money. Adding to this are growing fears over the impact of the financial crisis on care this winter.”
This means that last Thursday’s announcement presages a much more serious set of events for the NHS than a simple party political row. It could be the first sign that there is a real set of crises about to run through some trusts that will lead to a much bigger and wider political debate.
What is interesting is that the Secretary of State despairs of actually being able to solve these crises. Mike Farrar suggests ways of solving this crisis above (“To address this we need to start looking at the NHS’ big ticket costs such as how we deliver care and where. We need pragmatism and leadership to do this as it will involve some extremely difficult decisions.” )
In particular he calls for leadership in making difficult decisions.
That would help a lot wouldn’t it?
The 22 NHS trusts that the government believes are at risk because of PFI are: St Helens and Knowsley; South London Healthcare; University Hospitals Coventry and Warwickshire; Wye Valley; Barking, Havering and Redbridge; Worcester; Oxford Radcliffe/Nuffield Orthopaedic Centre; Barts and the London; University Hospitals of North Staffordshire; Dartford and Gravesham; North Cumbria; Portsmouth; Buckinghamshire; West Middlesex; Mid Yorkshire; Walsall; North Middlesex; North Bristol; Mid Essex; Maidstone and Tunbridge Wells; Sandwell and West Birmingham; (not yet fully signed off) and the Royal National Orthopaedic Hospital (not yet fully signed off).