It was the Labour party that decided to involve private finance in the NHS. It must pick up the pieces. Photo: Getty
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To save the NHS, Labour must face the ugly truth of PFI debts

Labour is right to focus on rescuing the NHS from the harm done by this government, but must face the truth that it was the party that introduced private finance into the health service in the first place.

Ed Miliband has said that this is going to be an “NHS summer”. He has sensed, rightly, that there’s something in the air, a tension over the precarious health service.

Strain on services is rising, the number of hospitals in the red is surging up, patient concern is growing and doctors are quitting in disgust at the ominous developments from the top. As much as the coalition would love to suppress them, the figures point towards a potential full-blown crisis before the parliamentary term is through. In August, campaigners will march for 300 miles, through 23 towns from Jarrow to London to press home these fears, and there are activists up and down the country straining just to get the same message across to the public: the NHS is in danger.

Labour has already made some firm commitments to undoing some of the harm done by the coalition. Andy Burnham has said in public, and behind closed doors to NHS activists, that he will repeal the Health and Social Care Act, and work to “scrap Cameron’s NHS market”. And the party has brought forward Clive Efford’s private member’s bill to rewrite rules forcing NHS contracts onto the market.

Labour should be commended for this. But if Miliband is serious about rescuing the NHS, there is an ugly truth to face. The NHS is riddled with extortionate debt from decades of misguided PFI deals. NHS hospitals owe £80bn in PFI loan unitary charges – in other words, the ongoing costs of maintaining PFI hospitals and paying back the loans. Next year alone, trusts will make some £2bn in repayments. Trusts like Peterborough and Stamford Hospitals NHS Trust, which is locked into making £40m in repayments a year on the PFI it took for Peterborough City Hospital, or Sherwood Forest NHS Trust, which is spending 15 per cent of its annual budget on the annual repayments on a PFI loan it took to expand the King’s Mill Hospital, and so on.

But there are plenty who do gain. The initial investment made by PFI companies is paid back in spades. As Joel Benjamin of Move Your Money points out: “Typically the unitary charge is three to five times the capital cost, and on more egregious PFI projects as high as seven times”.

The even uglier reality for Miliband is that the New Labour era was a golden age for the PFI. The modern PFI is the child of John Major’s Conservative government, but it was adopted and thrived under Tony Blair and Gordon Brown. Between 1997 and 2008, 90 per cent of all hospital construction funding was under PFI agreements, which paid for 75 per cent of all hospitals built.

The only positive, of course, is that 101 new hospitals were delivered in this time. New Labour invested heavily in the NHS, even if it did bring in some marketisation at the same time. Unlike this government, which has replaced marketisation with full-blown privatisation, and effectively cut budgets, especially for those with PFI debts, whose repayment rates are tacked to inflation.

Yet through a sustained campaign of attrition, the coalition has managed to shift the blame for “shortfalls” onto beleaguered health service staff and the principle of public care, and totally ignored the devastating role of the private finance cancer at the heart of it all. The next step is to present that same finance as the cure, and drive trusts that have been forced to cut back services just to balance the books straight into the waiting arms of private providers.

Figures published by the Nuffield Trust out today reveal the true extent of austerity’s toll on the NHS. In its report, Into the Red, the Nuffield Trust spells out how hospitals and trusts faced with austerity were just keeping their heads above water until last year, when “cracks” began to show. In 2013/14, a further 21 trusts had sunk into the red from the previous year, and overall trusts recorded a deficit of £100m. And the report reveals another sobering figure: of the health and social care leaders surveyed, 70 per cent said that they think more providers will be forced into the red to continue to provide high-quality care, if current levels continue.

Miliband has a real opportunity now: to rescue the NHS from another five years of this, and make huge political gains in the process. He could pledge to reform the PFI system, renegotiate the terms of existing loans agreed under duress to get payments down to “fair value”, which could even lead to a refund for some hospitals, or as has happened in selected cases, use public money to bail out hospitals crippled by debt. After all, it was good enough for the banks.

Not only would it free dozens of trusts like Peterborough and Sherwood Forest from the abject spiral of debt they’re in – and the negative impact that debt is having on healthcare – it would undermine the odious and transparently ideological argument that cuts to frontline services are needed to reduce the deficit. But that will involve facing up to the fact that it was his party, albeit under a very different leadership, that was so keen to get private finance involved in the first place. It would be a gutsy move, but a potential high earner. And it might just save the NHS.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

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19 things wrong with Daniel Hannan’s tweet about the women’s march

The crackpot and these women.

Since Daniel Hannan, a formerly obscure MEP, has emerged as the anointed intellectual of the Brexit elite, The Staggers is charting his ascendancy...

State of this:

I mean honestly, where do you even begin? Even by Daniel’s rarefied standards of idiocy, this is a stonker. How is it stupid? Let me count the ways.

1. “Our female head of government” implies the existence of “their female head of government”. Which is odd, because the tweet is clearly aimed at Hillary Clinton, who isn’t anybody’s head of government.

Way to kick someone when they’re down, Dan. What next? “So pleased that my daughter received a wide selection of Christmas presents, unlike those of certain families”?

2. I dunno, I’m no expert, but it’s just possible that there are reasons why so few women make it to the top of politics which don’t have anything to do with how marvellous Britain is.

3. Hillary Clinton was not “the last guy’s wife”. You can tell this, because she was not married to Barack Obama, whose wife is called Michelle. (Honestly, Daniel, I’m surprised you haven’t spotted the memes.)

4. She wasn’t married to the guy before him, come to that. Her husband stopped being president 16 years ago, since when she’s been elected to the Senate twice and served four years as Secretary of State.

5. I’m sure Hillary would love to have been able to run for president without reference to her husband – for the first few years of her marriage, indeed, she continued to call herself Hillary Rodham. But in 1980 Republican Frank White defeated Bill Clinton’s campaign to be re-elected as govenor of Arkansas, in part by mercilessly attacking the fact his wife still used her maiden name.

In the three decades since, Hillary has moved from Hillary Rodham, to Hillary Rodham Clinton, to Hillary Clinton. You can see this as a cynical response to conservative pressure, if you so wish – but let’s not pretend there was no pressure to subsume her political identity into that of her husband, eh? And let’s not forget that it came from your side of the fence, eh, Dan?

6. Also, let’s not forget that the woman you’re subtweeting is a hugely intelligent former senator and secretary of state, who Barack Obama described as the most qualified person ever to run for president. I’m sure you wouldn’t want to be so patronising as to imply that the only qualification she had was her husband, now, would you?

7. I’d love to know what qualifications Dan thinks are sufficient to become US president, and whether he believes a real estate mogul with an inherited fortune and a reality TV show has them.

8. Hillary Clinton got nearly 3m more votes than Donald Trump, by the way.

9. More votes than any white man who has ever run for president, in fact.

10. Certainly a lot more votes than Theresa May, who has never faced a general election as prime minister and became leader of the government by default after the only other candidate left in the race dropped out. Under the rules of British politics this is as legitimate a way of becoming PM as any, of course, I’m just not sure how winning a Tory leadership contest by default means she “ran in her own right” in a way that Hillary Clinton did not.

11. Incidentally, here’s a video of Daniel Hannan demanding Gordon Brown call an early election in 2009 on the grounds that “parliament has lost the moral mandate to carry on”.

So perhaps expecting him to understand how the British constitution works is expecting too much.

12. Why the hell is Hannan sniping at Hillary Clinton, who is not US president, when the man who is the new US president has, in three days, come out against press freedom, basic mathematics and objective reality? Sorry, I’m not moving past that.

13. Notice the way the tweet says that our “head of government” got there on merit. That’s because our “head of state” got the job because her great, great, great, great, great, great, great, great grandmother happened to be a protestant in 1701 and her uncle wanted to marry a divorcee – all of which makes it a bit difficult to say that our head of government “ran in her own right”.  But hey, whatever makes you happy.

14. Is Daniel calling the US a banana republic? I mean, it’s a position I have some sympathy with in this particular week, but it’s an odd fit with the way he gets all hot and bothered whenever someone starts talking about the English-speaking peoples.

15. Incidentally, he stole this tweet from his 14-year-old daughter:

16. Who talks, oddly, like a 45-year-old man.

17. And didn’t even credit her! It’s exactly this sort of thing which stops women making it to the top rank of politics, Daniel.

18. He tweeted that at 6.40am the day after the march. Like, he spent the whole of Saturday trying to come up with a zinger, and then eventually woke up early on the Sunday unable to resist stealing a line from his teenage daughter. One of the great orators of our age, ladies and gentlemen.

19. He thinks he can tweet this stuff without people pointing and laughing at him.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. He is on Twitter, almost continously, as @JonnElledge.