The Government’s Treatment of the Question of NHS Finances is Fraudulent

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Safeguard the Future of the NHS!
The Government’s Treatment of the Question of NHS Finances is Fraudulent

Workers’ Weekly Health Group

Following on from her declaration two weeks ago that the NHS was now out of "deficit" and "in budget" in an interview with the Financial Times, Patricia Hewitt has said that she expects that the "National Service will continue to grow, and grow faster than the rate of economic growth generally". She then went on to say that over the next 12 months "we will see, instead of constant financial problems, constant improvements", that the service would head towards reducing the total maximum wait for treatments to 18 months, and said that it was increasingly finding ways to treat people better, faster and for less money.

This treatment of the question of NHS finances is fraudulent. It is part and parcel of the government’s programme of "investment with reform" of public services designed to divert public funds so as to pay the rich. Cutbacks in the funding of the NHS are being disguised as "deficits" in budgets which last year were reported to be £547 million in an overall budget that will be £92 billion in 2007-8 in which the NHS as a whole is being urged to make up this shortfall with "efficiency" savings. Far from being due to inefficiency, this declared "deficit" represents in disguise an ongoing plan of hospital and service closures, job losses for nurses, doctors and support staff without any consideration for the effect on the people and their health care needs in their communities. The declaration that the NHS is now "in budget" is equally fraudulent. This declaration is based on the figures for the final quarter of last year that will be published in May and the latest forecast (Q3 figures). These show that the NHS as a whole was on track to deliver a "surplus" of £13 million by the end of the financial year. However, this has been brought about with a change in the Resources and Accounting Budgeting ¹ (RAB) when the "Government also announced that it would now allocate, as planned, the £450m contingency to the NHS". Then the boast that the health service "budget" now allegedly will "grow faster than the rate of economic growth generally" is based on Patricia Hewitt’ admission that the National Health Service may be funded at 3% and that inflation will remain as forecast at 2.75% when inflation is running at over 4% and set to rise.

These figures reveal the arbitrary nature of the concepts of "balance", "deficit" and "surplus" as the government applies them to the NHS. Overall, what is obscured is the whole question of how the health service is financed and whose responsibility it is. The government demands that health workers and health administrators get their budgets in balance rather than meet all the health care needs of their health population. This flies in the face of a government’s obligation to budget so as to provide the funding that meets the health care needs of the whole populations, assessed with the participation of health workers and health administrators.

Meanwhile, the government can announce good news or bad news, a funding crisis or new health care initiatives, at its own whim with little reference to the real problems that the health service and those who work within it face. So, for example, when Patricia Hewitt announced the new vision for maternity services, no funding was even allocated, let alone guaranteed, to provide for this vision. Instead, funding is expected to come out of existing budgets and lead to cuts elsewhere which the government will describe as "efficiencies". In stark contrast, when it comes to funding for the private sector, such as with PFI, these businesses are guaranteed vast resources in contracts paid over 30 or 40 years.

Furthermore, treating NHS funding as if it has to be assessed by thousands of accountants, as if it makes profit and loss, as if health care is on a bought sold basis with its built in mechanism to force the prices up and create shortages makes no sense and has nothing do with funding a modern health care system. Health care, like other vital public services, is not a commodity to be bought and sold. Health care is a right, and the people’s claim on society for this health care must be met. The right must be guaranteed through the allocation of the appropriate portion of wealth that society produces for the provision of health care to all members of that society.

In summary, one of the most important issues in safeguarding the future of the NHS is that of the funding of the health service and investments to safeguard its future. What is presently being obscured in all the furore over budgets are the competing interests in claiming the national social product. The health service is a social programme that produces no added value. It must be funded through an allocation of the social product created by social production. This allocation must be guided by the people’s needs. This is the responsibility of the government in setting its budget, rather than the responsibility lying with those involved in the provision of health care to jump through the hoops of a budget which imposes a rationing of health care.

Workers’ Weekly Health Group calls on the working class and people to oppose the diverting of funds into private sector monopolies, and to take a stand against the fraudulent claim by the government that there is a "financial crisis" in the NHS and therefore that efficiencies must be found, "productivity" raised, and services and hospitals closed, while showcase hospitals and other facilities which benefit the private sector receive practically unlimited resources. Suddenly now the NHS is supposed to be growing economically. What can this be but a justification for treating patients more "efficiently", i.e. cutting the level of care while pouring money into mega-health projects such as scandalous amounts wasted in lucrative contracts with the big IT companies, Treatment Centres, etc. Meanwhile, it is being floated that the obese, smokers, cancer sufferers and others are putting a strain on the funds of the NHS and will have to be made to pay for care or be denied treatment.

The demand must be for increased investments in the NHS with the outlawing of NHS contracts with privately-owned treatment and diagnostic centres and Private Finance Initiative contracts and the diverting of investment away from the NHS to create "profits" of these and other companies. There must also be a demand that no new contracts be signed, steps taken to bring back all private health care under public control, and a public investigation launched into the privateers with a view to reclaiming the huge profits for the public purse.

The demand to outlaw the involvement of the private sector in public services, the demand to stop paying the rich and increase investments in social programmes, is the demand of health workers everywhere and the working class and people as part of their affirmation that they have first claim on the economy as a whole. The issue is that health care is a right, and this right must be provided with a guarantee.

1. Note: The change in RAB means "overspending" NHS trusts which not only had to pay back their debts but also received less income the following year may not now receive less revenue as a result. However, this is not guaranteed as the government has left it to the Strategic Health Authorities to decide.