By Mike Fenwick
After the fuss made last year about an “overspend” in the NHS budget, the trend has been reversed. This year an underspend of some £550 million is predicted. That figure is conveniently near the previous and will be used to demonstrate how well managers have learnt the harsh business realities of the new NHS and the need to balance the books.
But another way to look at it is that over half a billion pounds wasn’t spent on patient care. The surplus does not mean all the outstanding health care needs of the previous year were met. People know what is really going on: waiting for a GP appointment, an operation in a rundown, understaffed hospital...
Time and again the notion of imposing a business, private sector, model on the NHS has been shown to be false. Despite the introduction of market mechanisms into the NHS it does not have the primary driver of big business in making a profit. New Labour has opened up possibilities or of others to profit in the healthservice, via PFI and private treatment centres, but the core purpose of delivering free care remains intact.
To measure the success of the NHS in its stated aim of providing healthcare for all, a different set of measures is needed. But any attempt at assessing society-wide benefit is neglected in the rush to fit the whole public sector into the framework of the market. The talk in the boardrooms is now all targets and performance, in preparation for a wholesale move toward Foundation Trusts and worse.
Another lesson already learnt from the private sector is fiddling the books. According to the Guardian this year’s budget was carefully manipulated to present a surplus — largely in order to save Hewitt’s job. Halfway through the year Trusts were reporting serious deficits. This led to a winter round of cuts, with jobs lost and patients subjected to longer waiting times. At the end of March, £450 million of contingency money was released, too late to be spent on care, but not too late to reduce the number of trusts showing a deficit.
In the next year big cuts and savings are already planned. Reports say £117 million will come from training budgets, and the staging of nurses’ pay award will save £60 million. At the same time £350 million a year has been signed away in new contracts for independent sector treatment centres, and other deals are on the table.
While this goes on, the main health union Unison is still just talking about industrial action over pay; the long awaited national demo in defence of the NHS in October is still not confirmed for London. While the unions bluster, New Labour’s plans to transform the NHS press ahead.