The British Medical Association (BMA) has today unveiled a set of New Year’s resolutions for politicians to help them protect the future of the National Health Service (NHS).
Top of the list is a resolution calling on politicians to stop wasting taxpayers’ money on unnecessary and expensive commercial sector solutions for the NHS in England.
‘These scarce resources should be invested in the NHS where they will provide better value for money and help more patients,’ said Chairman of Council of the BMA, Dr Hamish Meldrum.
He added: ‘The political parties have been grappling with the current financial crisis and cuts in the public sector are being proposed from 2010 onwards.
‘The BMA is calling on politicians to resist the false economy of making quick savings by cutting front-line NHS services.
‘Instead we urge them to use our resolutions to protect and improve the health service. The government needs to value doctors and invest in their education and training.
‘The NHS is currently running at full capacity. Recessions add to the burden on the NHS and the unexpected is always around the corner. The health service needs to be prepared for all eventualities.
‘Looking ahead to 2010, the BMA also wants the government to focus on wider public health issues including alcohol misuse, tobacco control and obesity.
‘Dealing effectively with these problems could save millions of premature deaths in the future. We hope this government – and any future government – will adopt our resolutions.’
The BMA is urging all parties to make the following New Year resolutions and stick to them:
‘1. Stop wasting taxpayers’ money on poor value contracts between the NHS and private companies.
‘2. Don’t cut frontline services, or penalise NHS staff to bail the country out of the financial crisis which was not of their making.
‘3. Safeguard funding for medical research and the education and training of clinical staff.
‘4. Work towards creating a tobacco-free society by 2035.
‘5. Set a minimum price per unit of alcohol and ban all alcohol advertising in the media.
‘6. Support and develop general practice to deliver high-quality care for patients.
‘7. Discourage trusts from cutting the time consultants can spend on initiatives to improve quality, patient safety and cost effectiveness.
‘8. Don’t raise the cap on tuition fees in 2010 – a move which would send the cost of a medical degree soaring and dissuade the less well off to study medicine.
‘9. Address the BMA’s serious concerns over the quality and continuity of junior doctors’ training.
‘10. Compel the NHS to lead by example by reducing its carbon footprint.’
The BMA recently launched its manifesto for the forthcoming Westminster election. In this document, the BMA calls on all political parties:
‘to be realistic about what the NHS can deliver
‘to recognise that the UK needs investment in health more than ever
‘to pursue sound and evidence-based planning of services.
The BMA believes these three principles underpin the New Year resolutions above.
On December 22, the BMA put out the following briefing document, ‘NHS spending and the role of the private sector’.
The BMA warns: ‘Funding for the NHS in England is expected to come under pressure after 2011, and there may be real term reductions in spending on health.
‘The BMA understands the need for efficiency, but believes that the focus should be on cutting the waste resulting from commercial provision of NHS services, rather than on cuts to frontline care.
‘The following paper lists reports of money wasted as a result of market-driven reforms in the NHS.
‘Private Finance Initiative (PFI)
‘Under the Private Finance Initiative, the private sector has been contracted to provide new hospitals and other infrastructure and then lease them back to the state for 25 or 30 years.
‘A 2007 report from the Association of Chartered Certified Accountants stated: “Unlike capital charges from non-PFI hospitals, the charges raised against PFI schemes represent revenue paid to private consortia and lost from the NHS.
“More schemes will eventually ensure that more money leaves the NHS in this way.
“In 2004, it was estimated that capital charges from PFI schemes were costing the taxpayer £125m per year.”
‘The 2008 National Audit Office report, Making Changes in Operational PFI Projects stated that “An estimated £180 million was paid by public authorities to PFI contactors to undertake (contractual) changes in 2006.
‘According to a report in the Daily Telegraph, “during the spending review period in 2011-2014, PFI repayments will rise to £4.18 billion – an increase of over £1 billion at current levels.
“The inflexibility of PFI contracts means that it is more likely that hospitals will make cuts to services to meet their PFI repayments”. (Hospital to cut services to pay for £60bn private finance deal Daily Telegraph, 8 August 2009).
‘According to the Economist, “the Treasury recently established a unit to lend money to PFI projects that were experiencing difficulty in securing funds through the banks. In effect, public money is being used to prop up PFI projects”. (The Economist, print edition, 7 February 2009).
‘Research (published June 2009) carried out by Dr Chris Edwards of the University of East Anglia looked at one of the first PFI contracts agreed for Norfolk and Norwich University hospital (NNUH) and concluded that:
‘l £217 million could be saved if the contract were bought out from the private company that originally financed the deal.
‘l £2.4 billion could be saved on buying out the contracts of 53 PFI hospitals, assuming the same saving as NNUH (however, each hospital would have to be looked at in detail individually).
‘According to a BBC News report, “the University Hospitals of Leicester NHS Trust scrapped its PFI scheme due to spiralling costs. £23 million of public money had been wasted on initial preparations”.
Hospitals scrap revamp plan, BBC News Online, 20 July 2007.
‘According to a Times report in 2008, “HSBC made almost £100million from managing National Health Service hospitals where contractors charge taxpayers inflated bills for simple tasks, such as £210 to fit an electrical socket.
“The charges, paid at hospitals run by the bank’s subsidiary infrastructure company, raise questions about lax controls in Labour’s private finance initiative”. Hospitals run by HSBC, Times Online, 8 June 2008.
Independent Sector Treatment Centres (ISTCs)
‘Independent Sector Treatment Centres (ISTCs) are owned and run by the private sector, but contracted to provide NHS treatment.
‘They typically carry out large volumes of supposedly simple surgical procedures such as hip replacements.
‘The BMA is concerned that ISTCs are receiving millions of pounds for work which is not being carried out and still being paid, as their income is guaranteed.
‘This means more money is being paid into the private sector for less work than the NHS was promised.
‘Information provided by the Department of Health to the Health Select Committee showed that across the first wave of ISTCs the cost of work carried out was 12 per cent more expensive than the same work carried out by the NHS.
‘According to a report in the Health Service Journal “more than three years after opening, the Greater Manchester surgical centre has still delivered only 63 per cent of contracted value”. ISTCs: Where are all the patients? HSJ, 18 Sep, 2008
‘Research published in the British Medical Journal on 30 April 2009 by academics at the Centre for International Public Health Policy at the University of Edinburgh found that in the first 13 months after the Scottish Regional Treatment Centre (SRTC) began accepting patients it carried out work worth only 18 per cent of its £5.6m annual contract for referrals.
They found that:
‘l there was “no evidence” to support claims that the centre was “efficient or good value for money”.
‘l the contract reporting requirements did not conform to NHS standards.
‘l Scottish health boards may have overpaid up to £3 million in the first year of the contract
‘l if the same findings apply in England then as much as £927 million or almost two thirds of the total first wave contracts worth £1.54 billion might have been overpaid to ISTCs.
Management consultants
‘The BMA believes NHS trusts are spending too much money on management consultants, often to help them with the burdens created by the development of the internal market.
‘The Royal College of Nursing has estimated that NHS trusts in England spent £350 million in the last financial year on external management consultants.
‘Figures recently published by the Department of Health in response to a Freedom of Information request, show departmental spending on consultancy projects for DH itself comes to over £125 million for 2008/09.
‘Costs for the three previous years came to: £132m in 2007-2008; £205m in 2006-2007; £133m in 2005-2006.
‘A 2009 report from the Management Consultancies Association estimated spending on management consultancy to the wider NHS for 2008 was £300 million.
‘A 2009 investigation by Pulse magazine found PCT spending on management consultants has more than tripled in the past two years. It analysed figures from 62 PCTs obtained under the Freedom of Information Act, and found:
‘l Each PCT is now spending an average of £1.217m on external companies: up from £361,000 since 2006-2007.
‘l The cost of legal and professional fees has also risen dramatically bringing the total paid to external companies to an average of £1.568m per PCT.
‘l NHS Tower Hamlets, hailed by ministers as a trailblazing PCT, reported the heaviest use of external consultants. It spent £5.682m on various projects in 2008, an eightfold increase since 2006-2007. Pulse, 20 May 2009’.
