It shocks me to read this sort of report in the FT:
The NHS has faced crisis before but this one is of a different order. It is estimated that it will have to fill a funding gap of close to £30bn a year by 2020. Financial failure is now deeply embedded across the entire system, afflicting prestigious hospitals and notorious laggards alike with about two-thirds of all UK hospitals forecast to be in the red by April 2016 according to the King's Fund. Their deficits look set to hit more than £2bn by the end of the financial year.
Addenbrooke's Hospital in Cambridge, a world-leading research centre, is in chaos this week, having lost its senior management and heading for special measures for the reasons noted above.
But let's be clear: I am not shocked by the deficits. I am not shocked by people resigning. I am not shocked by supposed financial failure. What shocks me is that there are people who think it appropriate to underfund the NHS in this way.
The NHS is very lean. Not perfect, but within the constraints of being a human led organisation meeting real human need, it's very good.
And in that real world these budget deficits and this funding crisis is not then a matter of people being profligate. Or of working so inefficiently. Or failing.
These deficits are instead the measure of an economic mantra that will not provide enough money to fund health care.
That thinks that the wholly unnecessary accounting goal of technically balancing its books is more important than people's lives and well-being.
That is denying people care because shrinking the state is more important than making people better.
We can fund the NHS. We have the underemployed and unemployed people in this country to put to work to do that. And we can train them. But we are being told, by some, that this cannot be done. And the reason is not because of any real constraint. Or any need. Or any threat to the economic stability of the country. It's just choice: the choice to put the book-keeping of a balanced budget above caring for the sick.
It's that choice that shocks me.
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Stand your ground on this one Richard. You are right. They are wrong.
You may not win the argument because there are a lot of very confused people out there (Andrew Neil being one of them) but nevertheless you are right.
However the bookkeeping can also illucidate the difference between currency assets and private bank money. I’ve got a simple spreadsheet somewhere that highlights this. I will dig it out later and send it to you.
It’s the stupidity that scares me!
Even though it’s been explained to them that it’s just not possible to balance the budget by cutting spending and raising taxes, the neo-liberals, in all parties, don’t change their thinking. I can’t believe they doubt what we say. Surely they will have noticed that tax receipts fall away when spending cuts are made and the economy falls into recession.
So it’s even worse than what you say. The Tory government are deliberately running the economy down for no good reason at all. There’ll be no balanced budget and the profitability of the useful parts of the economy will be reduced, meaning that there’s no hope of anyone wanting to make increased investments. Yet they somehow manage to convince themselves this is going to happen!
“shrinking the state is more important than making people better”. If JC or the new Health Secretary don’t say something along those lines and use it as a line to attack the Government with then they’re really missing a trick. Perfectly put.
The Tories are following a deliberate viscous cycle philosophy (if it can be called that)
We can’t have public services until the economy is ‘strong’-
But the economy can’t be strong without the Government spending
We’re living beyond our means
But our means are the Government Spending
etc,etc,etc.
So people die, commit suicide, gratuitously suffer to keep the corporate machine assuaged.
Underfunding the NHS, or even operating it on too lean a basis, reduces its efficiency rather than increasing it. One-off redundancy costs to reduce the on-going salary bill, and then expensive temporary contract staff to cover gaps. Patients held in A&E or corridors, waiting for beds – who then need to be looked after, at more expense than if they had been in a proper bed, with worse clinical outcomes. And so on.
This is a deliberate ploy that has been under way for some time. Deliberately run the NHS into the ground by closing local surgeries and A&Es, privatising more and more parts of it by stealth, then you reach a point where you say: “The NHS is in such a ruinous state, we cannot possibly afford to keep up a free service at the point of use. I’m afraid that we have to wake up to the fact that the NHS needs modernising and an alternative source of funding”.
Cue a insurance-style system based on the US system, teh corporate vultures swoop in, RIP NHS.
And sadly, we are allowing it to happen.
From wikipedia: “The Expansionary Fiscal Contraction (EFC) hypothesis predicts that, under certain limited circumstances, a major reduction in government spending that changes future expectations about taxes and government spending will expand private consumption, resulting in overall economic expansion.”
…a hypothesis disproved and discredited by the experience of the last five years.
Given the choice, you might think that Osborne has motivations way beyond real economic expansion; I couldn’t possibly comment.
Richard, wholeheartedly agree. At least we now have proper opposition to austerity and the running down of the NHS from the Labour party. I know you are at great pains to point out you are not part of the Corbyn team, but you are closely linked with aspects of this economic policy; and it struck me last night watching John McDonnell on Question Time that although he opposes austerity and champions investment, he is still operating within Osborne’s false framing around the deficit: ie the need to eliminate it. He once again committed to eliminating the deficit and claimed it could be done by making rich people and corporations pay the tax that they owe.
I have met JM, heard him speak many times, and I have a lot of time for him; but how do we get him away from this false premise that we need to be clearing the deficit? Perhaps you or Ann Pettifor could have a word with him!
I can try
If and when
And let’s not forget, Richard, that much of this “cost” is a direct result of the previous government’s “Lansley” reforms. These were supposed to save money – of course – though I know of no evaluation or research that says they have done. Instead, what I hear from the students who work in the NHS, and from a colleague who researches it is, increased complexity, increased bureaucracy, increased fragmentation, increased legal/contractual costs, greater use of management consultants, and so on. All of which take resources away from actual health care.
Mind you, as another comment notes, this is deliberate, of course. Create the conditions for the system to collapse and then invite in those private sector “saviours” to rescue it. Disaster capitalism applied to the NHS rather than a country. That’s all this really is.
It sounds like the NHS is doing a fine job right here, right now. A lean machine delivering good outcomes. Well done to them.
It should be noted that the FT is not calling for more NHS. It’s just pointing out the budget problem.
And those people who want to take more responsibility for their own health by taking some ahem alternative routes to healthy living ( cycling, e-cigs, punting ) have never had it so good.
Of course it never occurs to Neoliberals that if commercial banks ran their affairs like they want governments to and have to save before they can make loans the economy would rapidly deflate. Lazy analysis of all things monetary prevails in the UK and this has to be changed by a campaign to educate the electorate in how their monetary system really works. This would include recognising that Neoliberal ideology is in part “The Revenge of the Rentiers” who want to preserve the value of the money they’ve made by ensuring a “positive” interest rate is available to them in all inflationary conditions and this “want” will never go away. Recognising this helps to get the “rentiers” to back off applying Austerian policies.
You just cannot keep doing more with less. Have just had occasion to be a patient, wonderful they were, my old A E stomping ground.
My niece is a theatre staff nurse and doing such long hours on complex procedures, now being told more such ops with same staff.
The government know exactly what they are doing, it is planned . That so many of all persuasions did not oppose the 2012 health and social care act pains me beyond words. They did not tinker with it, their intention always was to destroy something magnificent so as to be able to create a continuous flow of cash. Of course teaching and many other wonderful services are a target for this despicable crew.