A Coalition Health Check

With the machinations within the Labour party and the relationship with unions taking centre stage, you can be forgiven for failing to see a small article that briefly graced the BBC website about redundancies in the NHS.


The headline read that ‘NHS redundancies have cost £435millon since April’. The cost in terms of bodies is 10,000 but this disguises the amounts that are paid in real terms.


According to the National Audit Office [NAO] 44 very senior managers have been laid off at a cost of £578,470 with the average payout at £277,273; the lowest was £33,771.


We do have to balance this against the implementation of the reforms in the NHS [England] that were designed to reduce the administrative infrastructure and the numbers of managers to make health more patient need focused. Well they seem to have managed the former but what of the latter?


So what we see is that so far the cost of re-managing the NHS is £1.1 billion, but set not to exceed £1.7 billion.  [We shall see if they can manage to achieve this or will simply fudge the figures in the hope we do not notice!]


But the transition has seen 170 organisations close and 240 created. Unless I am mistaken that means that so far 70 new bodies have been established which we assume need admin, premises, IT, staff and all the other paraphernalia to operate. With the mantra from the coalition that we need to be leaner and fitter you cannot help but wonder how creating more than you started with makes sense.


Ahh, but the coalition has a cunning plan! The changes they have and will introduce to health care in England will, in the long term, be good for patients and good for health. The problem with rhetoric is that it should be backed by some science or evidence. Unless you are the coalition in which case neither applies as the NAO has found that ‘some of the clinical commissioning groups, led by GP’s, lacked credible financial plans’ which ‘raises concerns about their ability to make savings and remain financially sustainable in coming years.’  So, if the whole idea of introducing competition in the NHS is to save money and the groups that are designed to do this could not organise the proverbial in a brewery, exactly where are we going with this new structure?


Maybe the answer lies elsewhere.


Since the passing of the legislation 3 months ago to open up the NHS in England to outsourcing, an estimated £1.5 million worth of contracts have been signed.  So far outsourcing has been fastest in diagnostics [not specified], mental health, domiciliary care and pharmacy.


Even more disturbing is that of the numbers of contracts awarded [16] since April only two were awarded to the NHS, with all others to private companies or enterprises. Since one of the key elements of the changes was some assurance from the Ministers that the NHS would be an equal partner you either assume that the NHS has failed to be competitive or that private industry has cut its cloth to beat the NHS price. What appear to be missing from the information on tendering are the quality, maintenance and long term viability for any of the services that are listed for tender.


Bitter experience in the past has shown that when a company takes over a service, it is often quickly reorganised or merged with another provider or they up sticks and go back overseas or that cuts are made to staff and pay to remain competitive and any promises of protection forgotten.


With only three months into the transition only time will tell if the failures of the past come back to haunt us in the future. Mind you by then we will be into another election cycle, with ministers from all persuasions promising us the sky and the earth and a brighter future.


So as we all consider where we will be sunning ourselves over our summer hols, ponder if you will where we will be in the autumn. Will we be in clover – or up the creek without the paddle?


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