Down the Rabbit Hole; Incompetence or Corruption?

If you read just this sentence, then read this; this Tory Government has ‘cooked the books’ on NHS finances, cut the budget far below what is safe or feasible, and let patient’s suffer to pursue a political ideology.

Want more information? juniordoctorblog goes down the rabbit hole. Watch your step – it’s a proper mess in here.

Let’s start at a beginning.

Here is a graph.

Here is the NHS budget (navy line). Here is the number of hospital ‘episodes’ (purple line). Here is the % of A&E attenders waiting over 4 hours (orange line), and here is the pan-NHS deficit (charted bars). A&E and hospital activity has risen predictably and steadily, while the NHS budget has fallen progressively behind, at a rate of ~0.9%/year, meanwhile hospitals started in 2010 with a £1.5 billion surplus, and will finish 2016 with a probable £2.3 billion deficit.

Bottom line: we are already doing more and more with less and less, and we are in trouble.

NHS 2010-16

Let’s walk on. Mind your step, Andrew Lansley has been in here.

How did we get to this point?

Well here is the Public Accounts Committee meeting into NHS workforce planning – the four heads of the NHS sat down in front of a parade of MPs and revealed they didn’t really have a clue what was happening, with ‘7-day NHS’ plans or with the ‘junior doctor contract’.

The bosses of the health service were told they were ‘flying blind’ on some of the biggest issues in the NHS at the moment.

During the proceedings the panel were rather anxious to find out how the NHS has fallen into such massive debt. It would seem that in trying to meet ‘efficiency’ targets, or ‘cuts’ as we would say, “they discovered that it was too ambitious and, as a consequence, they had to find temporary staff […] to help to meet safety parameters”. This was very expensive.

The problem with healthcare is when you try to ‘cut costs’ you often actually create larger costs. Look at social care – by cutting social care provisions e.g. carers and social workers, you save a little bit of money, but the patient waiting in hospital for a social placement is then stuck in a hospital bed with hospital care for longer – this costs a great deal of money.

The best way to explain it I have come across is this. Imagine you own a van, and every year you drive it a little bit further, and carry a little bit more. Now imagine you decide to make it more ‘efficient’ to save money. You make the van lighter by removing the car rack. A lighter van drives longer distances for the same money. To save a bit more money you stop taking the van to the garage. A year goes by, driving further, carrying more. Next the gearbox breaks, you could’ve prevented that if you’d gone to the garage every year. That costs more money, but rather than pay to replace it you decide to make more ‘efficiencies’. You sell off the wing mirrors and the bonnet one year, then sell the passenger seat, and the electrics the next. Before long you are driving further than ever before, on the same budget, but your van has no doors or windows. It’s not safe. You still won’t invest any more money, still want to drive it further. Next you sell the wheels and the engine. The budget is balanced, but the van is dead. A neighbour then says “Do you want to rent my van? It’s more expensive, and it’s not as good as your van was, but it’s all you’ve got.” Your neighbour is Richard Branson.

But I digress.

Let’s keep going. Here is a report to the public accounts committee on NHS finances, released this week.

Here’s a few highlights;

“The financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable”

“There is not yet a convincing plan in place for closing the £22 billion efficiency gap and avoiding a ‘black hole’ in NHS finances.”

But we knew all that already. So who is to blame?

Let’s dig a little deeper. Watch your head.

Here’s some written evidence from an anonymous whistleblowing financial director of a NHS hospital – they were frightened to give their name publicly for fear they would lose their job.

They are concerned that “patient safety and quality of care may be compromised by trusts’ short term actions to reduce headcount” but even worse that financial directors are making ‘questionable adjustments’ to their accounts which are ‘merely window-dressing’ to their accounts to please ‘no 10 influence’. Through several dodgy practices, including a ‘Capital-To-Revenue’ Transfer scheme- which essentially means the Department of Health pays money to hospitals, which record revenue, and then pay it straight back to the Dept of Health, which record ‘capital’. When trusts find they cannot pay costs, like the wages of their staff, the government steps in, but only with large strings attached, that the hospital must make further cuts.

Bottom line: NHS trusts may have been ‘cooking the books’ in order to appear as if they are not making massive cuts and crumbling under the massive pressure of No.10 and treasury underfunding.

It’s hard to decide whether this is incompetence on the behalf of the department of health, or deliberate underfunding from David Cameron, to move to privatisation, which, without a democratic mandate, is corrupt.

In the meantime we cannot afford to staff our hospitals properly, we cannot afford to cope with the demand in A&E and into this crisis the government impose a completely unmodelled contract on junior doctors, and decide to pursue ‘7-day’ services and the ‘safest healthcare system in the world’. It’s as if the Titanic is sinking and the captain wants everyone to rearrange the deck chairs.

Where shall we go from here?

So, in 2009 David Cameron takes over the country. George Osbourne and Andrew Lansley take huge amounts of money out of the health service, while demand rises and rises. Later Jeremy Hunt, with aggressive No.10 and Treasury influence, continues to do the same, only now there is no slack to give, and the system starts to implode. This is a political ideology driving shambolic managers with few options to either ‘cook the books’ or get fired, and in the meantime the NHS is in the midst of the biggest crisis in it’s history. As it looks, it could be the last one- this time next year there won’t be an NHS if things carry on like this.

It doesn’t sound good for the Department of Health and Mr Hunt. Apparently some scallywags are taking them to court.

Anyway, I’m off. Make your own way out.




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