Revelations from Mid Staffordshire Hospitals Trust bring into focus a depressing and frightening reality and all the concerns and warnings raised about the government’s drive to privatise the NHS. 400 people more than would have been expected died because of poor care and as the management focused on gaining Foundation Trust status.
Foundation Trusts are a further step towards privatising hospitals, making them financially independent from the NHS and able to raise funds directly from the private sector. For those Trusts with Foundation status it is a green light to start competing for contracts to deliver services previously provided by other hospitals. It allows them to start negotiating local terms and conditions for workers, so undermining national agreements. It’s the market incarnate in the health service, and the only criterion for success the government has set is that these Trusts keep the books balanced.
So as people died not only did Monitor, the so-called watchdog, find “no regulatory concerns” with Mid Staffordshire, awarding it four out of five for performance, and the Healthcare Commission was rating the Trust as "fair" or "good".
Alyson Pollock, a leading academic critic of the government, says this focus on business and performance targets has led to Trusts “squeezing out more for less and driving out basic humanity and compassion”. She’s right.
The main goal in 2006-07 for Mid Staffs was to meet a target saving of £10 million and and cutting more than 150 jobs to do so, contributing to a shortage of 120 nurses. Budget cuts and nursing shortages were also found to have undermined care at Birmingham Children’s Hospitals, the other NHS scandal in recent weeks.
Among the shortcomings found at Mid Staffs were
• No all-day, on-call cover by consultants because of shortages meaning junior doctors left unsupervised with the most urgent and difficult patients.
• The use of two clinical decision units (CDUs), basically wating rooms, which staff said were used as dumping grounds to avoid breaching the four-hour target for being treated in A&E.
• Nurses who lacked training and equipment — often what they had wouldn’t work.
• The shortage of nurses on wards meant call buttons went unanswered. Relatives claimed patients were sometimes left for hours in wet or soiled sheets, or were left unattended in pain and discomfort.. Normal nursing routines such as turning patients at risk of developing pressure sores failed to happen leading to complications in recovery and further distress and delay for patients..
• The Trust was poor at identifying when things went wrong and managing risk. Some serious errors happened more than once and the Trust had high levels of complaints compared with other trusts.
All to save money, to meet a target not a need!
The NHS was in surplus last year returning money to the Treasury despite the government continuing to find funds to throw at their favourite PFI schemes and market initiatives.
For example in North Staffs the Primary Care Trust is looking at escaping from a contract with one of the Independent Sector Treatment Centres (private hospital) which the government forced them into. Nations Healthcare, the private contractor, is guaranteed income for the next year although they will only be carrying out a few of the operations they’ve been contracted to do. The total cost of the five year contract to the NHS will be £15 million. Just around 7% of patients in Stoke took up the offer of this choice of care, with the vast majority sticking with their local services.
A decent local hospital is always the first choice in every survey of patient opinion and the government’s dogmatic insistence on providing another choice is unwanted. So money is being wastefully spent in providing profit for some for the sake of offering a “choice” no-one asked for, at the cost of services people do want and need!
The forthcoming changes inside Primary Care Trusts, with a split between the purchaser and provider services, will repeat the same experience in community services with the goal set as becoming Foundation Trusts. Care and treatment of people, the human element that underpins the existence of the NHS, is set to become increasingly marginalised. In those areas of the service where targets are not set there is an even greater threat of neglect and poor care as exemplified by the Health Service and Local Authority Ombudsmen’s case studies of the deaths of six people with learning disabilities.
All these changes and the resulting tragedies may mean an upswing in public anger and demonstrations against attacks on local services and the increasingly likely threat of closures of whole hospitals. The local District General Hospitals that provide good local access to emergency and specialist medical services have been the backbone of the NHS since the 1960s but are now at significant risk. The growing trend to centralise specialisms in a few regional or national centres, alongside the creation of polyclinics, will undermine the future survial of the general hospital in a health economy where big is best.
There is no evidence that any of the recent changes in the NHS have led to better healthcare or significant increases in efficiency. Traditionally the admin costs in the NHS were always very low, at about 6% of the annual budget, as compared to triple that amount in the US system and elsewhere. Now that everything needs to be priced, invoiced, tagged and audited to provide information for the market the admin costs in the NHS has escalated to 15% and is likely to rise further yet.
As the government spends billions in repairing the damage done by an unfettered market in finance they continue to press ahead with imposing the same market madness onto the NHS. None of the main political parties, for all their criticism of the excesses of the bankers, are prepared to draw the conclusion that the market and capitalism will only ever provide for greed and not need.
There is already a warning from the health secretary that next year the NHS may not fulfil its commitments on pay as the budget is tightened to pay for the bank bailouts.
It will be the job of socialists, alongside NHS workers and the communities they serve, to defend the basic humanistic principles that gave rise to the NHS. Continuing support for that aim of “free healthcare for all, at the point of demand” will be one way to demonstrate that social solidarity still exists.