Forum Topic

Who Is To Blame For The Local NHS Funding Crisis?

In normal times the story on this site about the black hole in the finances of the local NHS would be attracting far more attention. However, this critical issue is being ignored because of Brexit.Listening to the Prime Minister making his very unconvincing address outside 10 Downing Street it was clear he does at least recognise the importance of the NHS to his chances of re-election. However, all the spending pledges made so far have proven to be pretty misleading with very little new money going to the service and certainly not enough to match increased demand.However, the opposition's record on this is not much better. Large amounts of tax payers' money were spent on opposing the Shaping a Healthy Future programme. This was certainly controversial but was at least a  considered response to the challenges facing the NHS and allowed utilisation of capital assets to fund provision. It's rejection has resulted in drift for the local service with more money having to be spent on maintaining aging facilities which are no longer appropriate for the needs of the service.

Andy Jones ● 2569d38 Comments

An increasing proportion of government spending is already going to the NHS and when people talk of 'austerity' they should be reminded that overall the state is spending more but departments outside health are being squeezed. Whoever is in power will be faced with this problem. The spending promises made by Boris Johnson about police, health and education are unrealisable in the current financial situation without budgetary limits being ignored. That is even assuming there is a Brexit deal. Without one there will be a massive squeeze on government finances (according to the government). The NHS will also be hit with a triple whammy — EU staff leaving, elderly expats returning and more expensive medicines and supplies in general. The pain to be taken by the health service may just be beginning.

Gordon Southwell ● 2569d

Yes the local plans were a charade in order to prop up the PFI bad deals such as west middlesex which was heavily criticised. So important hospitals like charing cross on prime land were to be sacrificed in order to prop up the finances. The PFI fiasco was something that has crippled the health service. more money may have gone in but it is being paid to bankers rather than nurses.

Peter Chadburn ● 2569d

PFI is a disaster for both the health service and for education where many schools will be 'beyond their sell-by date' before the loans are fully repaid.Although it was Major's 'government' that started the PFI fiasco we should all remember which party (a clue, in power from 1999-2010) championed it as the 'saviour of the NHS and extended its remit into education.

N V Brooks ● 2569d

That's a bit of a simplistic view of PFI. Lots of schools and hospitals were built that otherwise wouldn't have been. Whether we got a good deal on this largely depends on the details of the contract. In some cases they have been terribly negotiated and will end up costing us far more than the costs of borrowing and ongoing maintenance would have done. In others the outcome seems to have been broadly satisfactory particularly since health authorities learnt from earlier mistakes.PFI may be gone in its present form but given the cost pressures on the NHS it isn't likely that we will return to a totally public sector funding model in the future.

Andy Jones ● 2568d

Perhaps if a more simplistic view of the process had been taken we would not all be bemoaning the 'stich-up' PFI contracts entered into by so many national and local authorities.On a macro level, as example, would you take out a personal loan over 10 years on, say, a piece of technology with a design life of eight years?Of course you wouldn't but local authorities and government departments seemed overly-keen on mortgaging our future on such deals in the public sector.As you rightly say, the devil is in the detail, but I have not found a single PFI deal that was equitable to both parties and I have worked in the past to unravel a few.

N V Brooks ● 2568d

I worked on PFI projects as a financial advisor for local authorities and NHS Trusts some years ago and I could see they were a bad deal. New Labour built many hospitals under PFI replacing existing capacity bed for bed. They then announced a strategy of moving services into primary care facilities, which meant hospitals became under used and not generating sufficient notional income (under the internal market system in operation) to cover their costs. PFI might have been a good deal if buildings stayed the same over their lifetime, but the reality is schools and hospitals undergo numerous small changes over 30 years as needs change and PFI makes these changes hard and expensive to implement.

Vlod Barchuk ● 2568d

Are there any PFI deals in the local hospital trust that are contributing to this deficit?

Andy Jones ● 2568d

Andy I can't find either current figures for the NHS as a whole nor for individual trusts.Back in 2014, NHS PFI debts were £60 billion on build cost of £11 billion. The London Hospital PFI debt was the largest in NHS England totalling £115 million every year. West Middlesex's rebuild was a PFI project as was the revamp of Northwick park.

N V Brooks ● 2568d

Yes West Middlesex PFI was heavily criticised by the Audit Commission. Invented by 2 brain willets and loved by Gordon Brown and then slammed by Osborne in the election campaign and still the preferred method of subsidising Investment bankers. PFI can be compared to getting a mortgage from wonga.com. As previously described the needs change. We have the ridiculous situations where a hospital is built under PFI then certain services get contracted out to other suppliers but the hospital trust is still lumbered with costs. This happened in Norwich and in other places. Yes some of these newer hospitals are beautiful but so much money is being mismanaged. in the end the front line gets hit

Peter Chadburn ● 2568d

Why do we think we are so unable to do anything about these:https://www.theguardian.com/commentisfree/2017/aug/30/pfi-britain-hospital-trust-debt-burden-tax

Philippa Bond ● 2566d

It's a bit rich for The Guardian to criticise PFI which was massively promoted by the Bliar and Brown governments (although was started under the Major 'government').An abject lack of scrutiny by local Trusts and the 'corporate NHS' got us into this mess and we will need billions of pounds to buy out from under these contracts.Locally, West Middlesex (a Labour-era PFI project) was criticised by the Audit Commission for the nonsensical PFI contract into which it entered.Don't even look at schools. The massive Labour-era Schools Improvement Programme was largely PFI-funded with many schools reaching the end of their useful life before the initial PFI fund is repaid let alone the accumulating interest.Simply, never put 'so-called Socialists' anywhere near money.Short-term gain means long-term pain when they are involved.

N V Brooks ● 2566d

Absolutely correct, Socialists are useless with money. They certainly know how to spend though.Paying it back? Dunno, not my problem Guv!

Rosco White ● 2566d

https://www.theguardian.com/politics/2017/dec/27/hospital-pfi-firms-set-for-190m-windfall-from-tax-cuts-study

Philippa Bond ● 2566d

Yes, but we all know that no-one, apart from those who set up these onerous contracts, actually benefits.I would rather see an article which clearly 'points the finger' at the incompetents who agreed these contracts rather than the companies profiting from them.We should remember that the exponential growth of the PFI financers happened largely under the Bliar and Brown governments and hasn't abated since.

N V Brooks ● 2565d

"Yes, but we all know that no-one, apart from those who set up these onerous contracts, actually benefits."Not true.  Those using those facilities and those working in them benefit.  It is Tory policy to avoid expenditure on building and maintaining public works and infrastructure.  This eventually produces a crisis which has to be resolved by successor governments.

Philippa Bond ● 2564d

Do they benefit?Unlike some Socialists who believe that there exists a 'magic money tree' the realists know that the PFI contracts entered into have to be paid for from NHS and Education budgets. Money that could be used to provide front-line services.Do show me where such 'Tory policy' is either mandated or in print. I posted that it was the Major 'government' who, to their shame, initiated PFI but the acceleration of PFI and it's adoption as a 'panacea for all ills' occurred under the oversight of Bliar and Brown.

N V Brooks ● 2564d

Yes but you could hardly call bliar a socialist. When the tories in opposition campaigned against brown osborne was honest and very critical of the pfi and appeared to be wanting to scrap it as poor value but it seems to have carried on. But then Cameron in opposition had appeared to be to the left of bliar and brown!! funny how the tories are now vrexit party lite!! But PFI was appalling value and was the only game in town. a health trust in the west country wanted to build a new clinic and PFI was the only solution. But the local council then built the building under normal financing and leased to the local nhs at much lower cost. But the local issues are that by closing charing cross and ealing they will have enough money to subsidise the other hospitals. but then if they need to add beds to those hospitals another nioghtmare of PFI begins. Whether buying a tv from brighthouse or a mortgage from wonga PFI sits alongside as bad value.

Peter Chadburn ● 2564d

PFI makes Wonga and Brighthouse look like benevolent old uncles always willing to lend a hand.It is a long-term disaster caused by those only looking at short-term gain.A little like the 900,000+ non-jobs created under Labour by moying/creating government departments in the North East or with ridiculously generous creation/relocation packages which, the moment the contractual obligations expired saw virtually every company that benefited moving out or closing down. Billions were wasted by Labour on this programme buying votes with jobs.I saw this first-hand in the Dearne Valley enterprise zones (DVez, set up by Labour in 1995). Fortunes spent in 'Labour heartland' to attract jobs in call centres, most of which have closed (EOn, Capita, Orange and O2 were among those who benefited from DVEZ cash but have since closed/relocated affecting thousand of jobs).

N V Brooks ● 2564d

You're right these things are unmandated and not in print but happen because of the agenda of the neo-liberals who fund the party.

Philippa Bond ● 2564d

https://www.nao.org.uk/report/pfi-and-pf2/

Philippa Bond ● 2563d

Interestingly, the report to which you link alludes to the fact that less than 6% of capital projects are now PFI-funded as the Tories have reined-in the extent and scope of PFI (if you read the report in full).

N V Brooks ● 2563d

Touche' Mr Brooks!

Rosco White ● 2562d

Once so many British building companies had been bought up by facilities companies - just look at the number of old names Carillion swallowed - it became more obvious what was happening.  How anybody let alone any Government department could continue letting contracts when there were obviously problems with the existing is unbelievable.  There were a lot of small businesses who were unfortunately caught out because of their misplaced confidence in a Government contract.

Philippa Bond ● 2561d

As I posted before but will post again:the inexorable rise of Facilities Management companies happened between 1999-2010 under Labour administrations.Why any government still lets contracts to the likes of C(r)apita however bewilders me.

N V Brooks ● 2561d

"Why any government still lets contracts to the likes of C(r)apita however bewilders me"I imagine it's the lesser of two evils? The "Government" know they're useless and can't run anything properly, so Capita & Co run things only 99% useless, a 1% improvement, therefore the likes of Capita are a Good Thing - Value For Money?!!!

Rosco White ● 2561d

Hapless as he may have been, former Chancellor Phillip Hammond did at least formally block PFI for all new infrastructure projects last year.The use of PFI was very limited until 1997 but became widespread under the New Labour government.Two months after New Labour took office, the Health Secretary, Alan Milburn, announced that "when there is a limited amount of public-sector capital available, as there is, it's PFI or bust"

N V Brooks ● 2560d

Successive Tory governments from Thatcher to today have consistently run down the public estate leaving the crisis to be dealt with by following Labour governments.The underlying problem is the application of neo-liberal theories which deny the raising of appropriate taxation needed to maintain services and facilities.This is not a problem faced by other modern democracies in the world.

Philippa Bond ● 2558d

Please post something, anything, that has empiric evidence of Labour administrations leaving the economy in a better situation than they found it."This is not a problem faced by other modern democracies in the world."USA/ Ireland / France / Italy - all modern democracies with falling levels of public service and a reluctance to raise taxation but when have facts ever 'soiled' your posts.Please stick to recycling - an area where you know the subject.

N V Brooks ● 2558d

We've had 10 years of neo-liberal/Tory austerity leaving public services in a ruinous condition and the country teetering on the edge of recession - a proud record indeed!There was a time before Thatcher when "Conservatives" supported public services, built public housing, paid for the NHS and raised appropriate taxation.  Since the advent of free-market economic theories "Conservatives" have become radical "Right Wing Tories" and lost their connection with the old "One Nation".  This is why so many moderate Tories are jumping ship.  FACT!

Philippa Bond ● 2558d

I'll try again.Please post something, anything, that has empiric evidence of Labour administrations leaving the economy in a better situation than they found it.

N V Brooks ● 2558d

Why?  We are back where we started.  If you mean by economy the wellbeing of the rich then I have to agree with you Tory governments invariably increase the wealth of the very rich while removing essential services from everyone else.

Philippa Bond ● 2542d

One last time as even I have a limit to my patience.Please post something, anything, that has empiric evidence of Labour administrations leaving the economy in a better situation than they found it.

N V Brooks ● 2542d

I have replied - I just haven't given you the answer you want to hear."Only when the last tree has died, the last river been poisoned and the last fish has died will we realise that we cannot eat money."  Cree proverbNow look at the latest data on child poverty.

Philippa Bond ● 2542d

I despair.As you will not cannot answer a simple question, I will leave you to your delusion.As I posted before, you may be better served, and serve others better, by sticking to recycling.

N V Brooks ● 2542d

Well what about this:https://www.independent.co.uk/news/health/nhs-hospital-business-rate-private-charity-status-council-high-court-a8992206.html17 NHS Trusts to go to the High Court...

Philippa Bond ● 2534d

What about it?You can post as many links as you like.One LAST time.Please post something, anything, that has empiric evidence of Labour administrations leaving the economy in a better situation than they found it.

N V Brooks ● 2534d

https://www.nytimes.com/interactive/2019/10/06/opinion/income-tax-rate-wealthy.htmlWhat not to copy for the welfare of the country!  If only we had a fairer graduated tax system we would be able to provide the funds needed.  You should look at the graphs of peaks and troughs for yourself and pinpoint the crises to see where and when the economy was good and bad.

Philippa Bond ● 2534d

OK, I simply give up on people who won't or can't answer a simple question.

N V Brooks ● 2533d