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The Patient Is Bleeding Us Dry But Shows Few Signs Of Getting Better
The Telegraph (UK)k ^ | 9-25-2003

Posted on 09/24/2003 5:50:48 PM PDT by blam

The patient is bleeding us dry but shows few signs of getting better

(Filed: 25/09/2003)

Labour vowed to save the NHS - but it is proving an expensive promise. In the fourth part of our investigation into the state of public services Celia Hall gives the money-hungry beast a check-up.

During almost 20 years in opposition, there was one issue on which Labour could rely for voter support: the National Health Service. It had been the party in power when the NHS was established in 1948 and felt that it possessed proprietorial rights.

As demands for health care grew, Labour skilfully exploited the inevitable strains on the NHS and blamed the Conservatives for all its shortcomings. In the party's 1997 manifesto, this political artifice was deployed to powerful effect, encapsulated in the pledge: "We will save the NHS."

This slogan served a double purpose. It suggested the Conservatives were intent on destroying a national and comprehensive health service paid for predominantly through taxation and it promised better times ahead.

But it was also a hostage to fortune. After mercilessly battering the Tories over the years, if there was one public service above all that had to show significant signs of improvement under Labour it was the NHS.

As the party has found in six years of government, it was easier to shout from the touchline than to play on the field. Labour believed the solution to the ills of the NHS was to pump more and more money into the system and, on paper, it has shown signs of recovery. But in the wards, the surgeries and the clinics the vast investment is not making a huge amount of difference.

Once again, the complex and cumbersome NHS is showing a remarkable sponge-like quality, soaking up the money but achieving only patchy progress, something even ministers acknowledge. No one, apart from some union leaders, any longer believes that greater amounts of public money alone can forge the necessary changes.

The investment in the NHS is truly colossal. Three years ago, Tony Blair - stung by criticism of Britain's "Third World" health service - somewhat rashly promised to bring spending up to the European average.

In 1998 the NHS was getting 5.6 per cent of GDP, about half that of some comparable European countries. By 2000, this had risen to 6.8 per cent compared with a European average of eight per cent. By 2008, we should be spending 8.2 per cent.

In 1948, the NHS cost £788 million to run. When Labour came to power in 1997, it was receiving £34.7 billion. By 2002-03, this had risen to £60 billion - an increase of £5.2 billion over the previous year.

The biggest injection of all was announced in the 2002 budget when Gordon Brown, the Chancellor, unveiled a five-year plan with about seven per cent growth each year to 2007-08, when the sum is set to reach an astonishing £90.2 billion.

This money is having an impact. The Government is meeting, and has met, some of its much criticised targets designed to drive down waiting times and to raise standards. And while the figures may be disputed - and dramatic waiting list fiddles have been exposed - it is generally agreed that there are more doctors and nurses, that waiting times are shorter, that more drugs are being prescribed, that more equipment has been bought and that more patients are being treated.

There is even talk of the "first green shoots" of recovery. A nurse no longer has to spend half her shift tracking down a clean pillow case because the linen cupboard is now stocked. A surgeon can get a new blade for a scalpel. Scanners are being bought.

The extra money is welcome but, among doctors, managers and even civil servants, there remains profound pessimism for the future of the NHS. Across the board the Government is criticised for micro-managing the system. Ministers say that they are relaxing their iron grip but managers have found little evidence of this.

No doubt the extra £5.2 billion in 2002-03 bought some more hip replacement operations at £4,500 each or heart by-pass operations at £9,000 each or out-patient appointments at £100 each or visits to the A&E department at £100 each on average.

The fact is that 75 per cent of NHS funding goes on paying the enormous workforce of 1.4 million. Of the additional money in the year to April, £1.6 billion was spent on pay inflation for existing staff and £1.3 billion on pay for new staff.

In the first year of extra money (2001-2002), there is general agreement that most of what was left after salaries had been paid went on debt repayment. Hospital activity actually went down.

What is surprising is that NHS trusts are still facing millions of pounds of debts. Within the NHS, people say it is proving to be a tight financial year with trusts already imposing spending restrictions on "extras" such as educational courses.

Jim Johnson, a consultant surgeon working in Cheshire and chairman of the British Medical Association, says his own trust is looking at a £7 million deficit. "It is a typical trust and you will see the same pattern in many trusts across the country." But he was recently asked to see what cuts could be made in post-graduate education.

Prof Tony Mundy, a medical director at University College Hospital, London, one of the most successful hospital trusts, said: "The money has gone into the health service but not into health.

"Hundreds of millions have been spent on new monitoring and regulatory bodies. Yet we are working on tighter and tighter budgets, targets are being ratcheted up higher and higher and it becomes impossible to meet them."

Many of these costly bodies were created by the NHS Plan, published in 2000. They include the National Institute for Clinical Excellence (Nice) and the Commission for Health Improvement (Chi). Alongside these are the NHS Modernisation Agency and half a dozen health "tsars" and their staff appointed to promote good practice.

The running costs of Nice, which advises on drugs and treatments, was £12.5 million last year. Chi, soon to expand into the Commission for Healthcare Audit and Inspection (Chai), will investigate standards in the private sector as well as the NHS. Start-up costs are £15 million and its running costs are estimated to be £60 million in 2004-05.

The NHS Plan is a 10-year project but, because politicians want faster results, there have been bizarre innovations such as allowing patients who have waited more than six months for heart surgery to choose where to have the operation.

Earlier this month, the NHS paid for a Birmingham man to have a heart by-pass in Belgium when the NHS-owned Heart Hospital in London was under-used and half empty. The Department of Health said costs of treating patients abroad are comparable.

Waste is endemic in the NHS. The public accounts committee says elderly people blocking hospital beds, because provision has not been made for them at home, costs £170 million a year.

Some even say the NHS was more efficient five years ago when it had less money. "In the past, managers balanced the books by not doing things they should have been doing. They would just say No to a request for a new surgeon or a new drug because they could not afford it," said Nigel Edwards, director of policy at the NHS Confederation representing managers.

"The infrastructure and the underpinning became ropey to say the least and a lot of the new money has just been about putting back what should have been there in the first place.

"Many of the improvements are hard to grow. It takes time, for example to train staff and some of the improvements will never be seen."

Some innovation makes sense. Diagnostics and Treatment Centres (DCTs) will separate waiting list cases from emergency surgery, which always takes precedence. The £2 billion scheme should treat 250,000 patients a year by 2005 in the new units, some of them privately owned. The DCTs will provide specific treatments such as joint replacements or cataract surgery.

Many consultants do not like the idea, fearing their own NHS departments will wither and that trainee consultants will not get the necessary experience. Some worry about their private practice.

The current vogue word in NHS is choice. John Reid, the Health Secretary, has promised that by 2005 everyone will be able to choose from five places to have their operations.

But what patients want is treatment within weeks at a hospital near home that will provide a good standard of modern care. Choice seems like an expensive luxury when the underlying problem remains lack of capacity to cope with demand for treatment.


TOPICS: News/Current Events
KEYWORDS: better; bleeding; dry; few; patient; sign
Sounds like public education in the USA.
1 posted on 09/24/2003 5:50:49 PM PDT by blam
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To: blam
The public accounts committee says elderly people blocking hospital beds, because provision has not been made for them at home, costs £170 million a year.

Huh?

2 posted on 09/24/2003 5:53:37 PM PDT by mewzilla
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To: blam
Does Hillary know about this?
3 posted on 09/24/2003 5:59:28 PM PDT by tbpiper
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To: blam
x
4 posted on 09/24/2003 5:59:50 PM PDT by Robe (Rome did not create a great empire with meetings, they did it by killing all those who opposed them)
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To: mewzilla
"Huh?"

Dump grandma at the hospital and refuse to take her back home?

5 posted on 09/24/2003 6:06:19 PM PDT by blam
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To: blam
And they're hiring HIV positive nurses from Africa ...
6 posted on 09/24/2003 6:29:46 PM PDT by 1066AD
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To: 1066AD; blam
And they're hiring HIV positive nurses from Africa ...

That way they don't have to worry about paying them retirement benefits.

7 posted on 09/24/2003 6:59:31 PM PDT by Paleo Conservative (Do not remove this tag under penalty of law.)
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To: blam
NHS and the National Plan, over the years, have proven EXACTLY one thing:

Socialists not only can't add, they can't be bothered even to try. As Rand put it, in Atlas Shrugged, p.1025 of the Signet paperbound edition:

''Which one of us would succeed, if I were to compete with you for control of your musclemen? Sure -- I could pretend, and I wouldn't save your economy or your system, nothing can save them now -- but I'd perish and what you'd win would be what you've always won in the past; a postponement, one more stay of execution, for another year -- or month -- bought at the price of whatever hope and effort might still be squeezed out of the best of the human remnants left around you, including me. A month? You'd settle for a week -- on the unchallenged absolute that there will always be another victim to find. But you've found your last victim, the one who refuses to play his historical part. The game is up, brother.''

The only question remaining, regarding taxpayer-paid ''health care for all'' is which existing system goes bankrupt NEXT. Place your bets, ladies and gentlemen.

8 posted on 09/24/2003 8:25:35 PM PDT by SAJ
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To: SAJ
Yup. Read Atlas Shrugged at age 19, 40 years ago.
9 posted on 09/24/2003 8:29:26 PM PDT by blam
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To: blam
She certainly didn't get it ALL correct, just 95% or so. WAY better than most folks could do (hell's bells, MOST folks wouldn't even have tried to expound these principles, and, had they, would not have expounded them so clearly).

Best regards, and a full FReeper BUMP to you, sir (I assume, ''sir''; apols if incorrect).

10 posted on 09/24/2003 8:48:30 PM PDT by SAJ
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