I'll cut the NHS and raise the deficit

It was inevitable, but now the figures are out: Cameron has cut the NHS. The Financial Times reports:

"Treasury figures show the NHS spent £102bn from April 2010-April 2011, almost all of which took place when the coalition took power. This marked a £750m real-term fall from the previous year, something Mr Cameron repeatedly promised would not happen. ... Treasury officials pointed out that this spending had taken place under plans originally put in place by Labour. But under those plans, spending should have risen in real terms by £150m."

On the other hand the Conservative government is borrowing even more than the previous Labour government:

"A fall in tax receipts got the new fiscal year off to a disappointing start with public sector net borrowing hitting £7.7bn compared with £5.3bn in April last year."

Remember that poster: I'll cut the deficit not the NHS. Well he got it the wrong way round, in practice he cut the NHS and raised the deficit.

When it comes to hypocrisy, Lib Dems are the Masters

Unless, of course, you are a Minister. The government was adamant during the white paper: all NHS Trusts have to become a Foundation Trust by April 2014, to do this each Trust had to match the tight financial criteria that Monitor sets and any Trust that failed to become a Foundation Trust would close. The Health and Social Care Bill reinforces this market-based way of reconfiguring services. The drop-down-dead date was brought up in the Pause and the government has relinquished saying (in their response to the Future Forum):

We strongly expect that the majority of remaining NHS trusts will be authorised as foundation trusts by April 2014. ... It will not be an option to stay as an NHS trust, but there will no longer be a blanket deadline in the Bill for abolishing NHS trusts as legal entities. All NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for every trust. (7.17)

Note that an NHS Trust cannot remain as such (ie be treated as part of the public system of healthcare provision), under this government the only option is for a Trust to become an autonomous Foundation Trust over which the government will admit no responsibility.

Further, the government says:

To enable time for foundation trusts’ governors to build capability in holding their boards to account, we will further extend, to 2016, the transitional period where Monitor retains specific oversight powers over foundation trusts. Monitor’s oversight will last until two years after a foundation trust is authorised, if that is later. To provide continuity during a challenging period, and in recognition of concerns about the readiness of foundation trusts’ governors, these powers will initially apply to all foundation trusts, and they will be reviewed in 2016. (7.18)

This says that after 2016 (or two years after a trust becomes a Foundation Trust, whichever is the later) Foundation Trusts will be completely autonomous of the government or any government agency (including Monitor). This is the "level field" that Lansley keeps talking about because Monitor (as the economic regulator, rather than the Foundation Trust regulator) will treat FTs exactly the same as private and voluntary sector hospitals.

The point of quoting these paragraphs is to show you that the government is intent on allowing hospitals to close - and to use the market to close them. There are many reasons why a hospital loses money, and poor management is just one (and most likely not the most important reason). The hospital could be in an area of high deprivation or some other demographic with a high healthcare cost. The hospital could be in a rural area and consequently serve a population that is not large enough to be economic, but nevertheless be vital for that community.

It makes no sense at all simply to look at the balance sheet and close those hospitals in the red and allow those in the black to continue, the other criteria - the health inequalities in the community being one of the most important - should be taken into account. However, this requires a strategic and planned approach and this government does not do that.

Consequently, the government's market-led approach creates hypocrites of ministers. For example (from the Evening Standard),

In a startling admission, the Work and Pensions Secretary [Iain Duncan Smith] said waiting lists are already growing as he led a campaign against shutting the A&E and maternity units at King George Hospital, Ilford. The ex-Tory leader warned that thousands of patients in his constituency will suffer if the closures go ahead.

The last sentence actually explains his worry. It is not thousands of patients he is worried about, it is thousands of voters. However, Duncan Smith, if true to his ideology would do what politicians are supposed to do, and show leadership and explain to the voters why the hospital should suffer the closures that are the bedrock of his government's policy. He doesn't. He's a hypocrite.

However, hypocrisy is not the sole domain of the Conservative party: the Liberal Democrats are hypocrites too. HSJ reports that health minister, Paul Burstow says "services could be put “at risk” by a hospital merger proposed near his constituency on the Surrey-London borders". Burstow says

Any merger that could result in the loss of services, which local residents rely on, will not be tolerated. It is essential that we show local NHS bosses this.

Well, Mr Burstow, these market-based reconfigurations are your government's policy. If you are against them, then stop them all. It is pure and utter hypocrisy to say that they should happen everywhere else in the country but should not happen in his backyard where they will affect him electorally (majority 1,608 over Cons).

Vote for Public Services?

This is from the Open Public Services white paper:

Read the whole paragraph.

"We want to open up existing provision to competition from new providers with different ways of doing things. ...  in other areas it will mean people competing against one another through the democratic process to gain citizens’ votes."  

Doesn't the highlighted sentence describe the process of electing councillors and MPs? In which case, why is it in a paragraph about the provision of public services? Was this a cut 'n' paste error? Or does it mean that we will vote for who provides the public services in an area?

What do you really mean, Mr Clegg?

After all the hoo-ha over the Health and Social Care Bill and Lib Dems finally realising that it is just a plan to privatise the NHS we had a series of speeches from the Deputy Prime Minister where he told his supporters that he would protect the NHS.

For example (26 May):

"That’s why I have been absolutely clear: there will be no privatisation of the NHS."

And (14 June):

"You told us you were worried about privatisation through the back door. So we have made that impossible."

Yet in the Open Public Services white paper, it says

"In the services amenable to commissioning, the principles of open public services will switch the default from one where the state provides the service itself to one where the state commissions the service from a range of diverse providers." (5.2)

It is very clear here. There will be no state provision in the NHS. How can Clegg say that this is not privatisation? Who is he trying to fool?

QIPP

The NHS "efficiency savings" is frequently misreported, journalists, MPs and the public don't really know what it is or how big it is. Mistakes are easy to make when reporting it, although you would have thought that an MP would check before talking about the cuts in Parliament (like Nahdim Zahawi who thought that the cuts would occur all in one year).

However, the one organisation you would expect to actually know what the "efficiency savings" cuts are, is the Department of Health. Apparently not.

The page for the documents on QIPP says:

"The quality, innovation, productivity and prevention (QIPP) challenge is our opportunity to prepare the NHS to defend and promote high quality care in a tighter economic climate. We know we have one more year of guaranteed growth in 2010/11, but the NHS needs to be making efficiency savings of £15-£20 billion per year by 2013/14."

Nope. This is a Zahawi error. The £15-£20bn is to total over the period, not the annual "saving".

Of course, this document has now been superseded so that the "efficiency savings" are £20bn over the period 2011/12 to 2014/15. That is, Labour wanted a minimum of £15bn over 3 years and the Conservatives want a minimum of £20bn over 4 years.

A poor show from Miliband

It was a poor show from Ed Miliband at Prime Minister's Questions today. The last few weeks should have been clear to Miliband that when you press the Prime Minister on details he falls to pieces and then starts saying things that he wished he hadn't. Today the schedule was clear: the Prime Minister would make a lengthy statement on the BSkyB takeover and there would be a debate, then later in the afternoon there would be an opposition day debate on the BSkyB takeover. Clearly Cameron would be well briefed on the BSkyB takeover. So what did Miliband choose to ask at PMQs? Yes, the BSkyB takeover!

There was also an orchestrated attempt by Labour MPs to only ask questions on the BSkyB takeover (or Murdoch). From a political point of view this was a daft approach because all it resulted in was a repeat of the same replies. If I had been Miliband I would have asked:

Will the Prime Minister apologise for insulting all the GPs in this country when he suggested that they are corrupt by implying that the only way that patients can get emergency treatment is if they have dined with their GP?

The Open Public Services white paper is a threat to our public services, and it deserved a mention today. Five questions targeted at the details of this policy would have wrong footed Cameron and highlighted the danger of this policy to the public. Today was a wasted opportunity from Ed Miliband.

Pathetic, pathetic, pathetic

... Labour, that is.

Yesterday Cameron put a huge For Sale sign on our public services. So what was Labour's response? The pathetic Tessa Jowell said:

This White Paper contains few new ideas and even fewer new proposals. Having promised radical change, the Tory-led Government are lagging behind their earlier rhetoric and are yet to catch up with the last Labour Government.

Does she really think that Cameron's plan to privatise everything is "yet to catch up with" Labour? If so, then Labour's privatisation policies are truly incredible. This is totally unacceptable.

If I were to be kind to Jowell I would say that this statement was made out of complete ignorance of Cameron's policy, and that is also unacceptable.

Labour, you have to up your game.