Tory wasters: Rishi Sunak and Steve Barclay have wasted billions of pounds that could have paid for much more than the pay rises demanded by doctors, nurses and ambulance crews. If they withheld it because they’re trying to steer us towards privatisation, they have failed.

The Conservatives have been paying billions of pounds to private health-related companies for services that have not been provided – while accusing striking doctors, nurses and ambulance staff of jeopardising patient care.

Exhibit A:

From the article:

Experts say the figure is just scratching the surface, with NHS bosses in England having been given the green light to spend up to £10bn on private health companies as part of the government’s plan to reduce the record number of patients waiting for care.

The biggest beneficiary of the outsourcing has been the Australian healthcare multinational Ramsay, which received £134m to offer non-emergency care to NHS patients between 2021 and 2022.

Spire Healthcare, which operates 38 private hospitals formerly owned by Bupa, has been handed a further £108m over the same period. Circle, which is owned by Centene, one of the biggest US healthcare corporations, was paid £50m.

A further 30 private companies, which also include the Nuffield Trust and Specsavers, have been paid £195m in total as part of a contract aimed at boosting the number of patients the NHS treats in England between 2021 and 2022.

The data was obtained by openDemocracy through a Freedom of Information request to all 42 NHS Integrated Care Boards, which are responsible for spending and managing NHS budgets regionally in England. Only 23 responded to openDemocracy’s request, meaning the total cost could be significantly higher.

But the number of patients being treated has not recovered even to pre-Covid-19 levels:

Between January and November 2022, the NHS treated 6.6% fewer patients from elective care waiting lists than it did over the same period in 2019, according to an analysis by the Institute of Fiscal Studies.

The think tank said in February that the NHS was “clearly lagging” behind its target to increase the number of people it is treating to around 30% above pre-pandemic levels by 2024/25.

Exhibit B:

From the article:

The department spent £8.9bn during 2020-21 and another £6bn last year on such supplies, including masks and gowns for NHS staff that have proved unuseable and are now being burned.

The sums were revealed in the Department of Health and Social Care’s (DHSC) annual accounts and report for 2021-22, published on Thursday, and highlighted in a highly critical assessment issued by the National Audit Office (NAO).

The DHSC’s report also disclosed that it expects to spend £319m storing and disposing of PPE which is no longer needed and is of such poor quality that it is no use to frontline staff anyway.

In March last year it was still spending £24m a month storing the infection-preventing equipment, the NAO said.

On the subject of storage, there’s this:

Exhibit C:

From the article:

i analysis of figures provided by NHS bodies showed that strikes by junior doctors, nurses, ambulance and other health workers have already led to 665,000 cancelled appointments or operations.

NHS Providers in March said 140,000 appointments were postponed due to nurses and ambulance workers walking out between December and mid-March.

NHS England said the first junior doctors strike last month caused the cancellation of 175,000 operations and appointments.

Up to 350,000 appointments could have been cancelled during the unprecedented four-day junior doctors walkout last week, the NHS Confederation estimated.

Separately, NHS England analysis said the first nurse walkouts on 15 and 20 December caused the cancellation of almost 30,000 operations and appointments.

This is not justification for government investment in the private sector, though. Quite the opposite.

Let’s go back to that Open Democracy article for a moment:

Junior doctors are asking for a 35% pay rise to reverse 15 years of below-inflation wage increases.

The BMA calculates that the net cost of the pay rise for the government would be £1.03bn – a tenth of the potential spending on private healthcare companies. Even the £500m spent last year could have funded an 8% uplift in junior doctor wages for the year in question.

Add nurses and ambulance staff to the calculation and bringing their pay up to parity with 2008 or 2010 levels would still cost a fraction of what Rishi Sunak and his government have wasted – let’s be clear on that: wasted – on private health firms that simply do not help.

Exhibit D:

The Tories don’t want to go into talks with preconditions, and won’t talk if strike action is likely. In other words, the only talks they want are if they tell the nurses (and other NHS staff) what they have to take. No union representative will accept those – let’s face it – preconditions. In any case, it is hypocritical of the Tory government to demand preconditions while condemning nurses for having any of their own.

Exhibit E:

From the article:

From a peak of 70 per cent in 2010, overall satisfaction with the NHS has fallen to just 29 per cent – the lowest figure recorded since this question was first asked in 1983. Satisfaction with individual NHS services is at record lows across the board, while satisfaction with social care is the lowest of all with only 14 per cent of the public saying they are satisfied with it.

Yet none of this translates into any appetite for user charging or a different funding model, the first options that some commentators flailing around for a magical solution tend to clutch at. The public’s aspirations seem straightforward: they simply want an NHS that does what it says on the tin and that works. They were highly satisfied with a system that provided this as recently as 12 years ago, and they do not accept that this is too much to ask.

This may come as a huge disappointment to leading Tories, who are generally believed to have spent the last 13 years de-funding the NHS in order to stop it working properly, in the belief that public opinion would swing behind changing to a US-style, insurance-based, privately-run health system.

So what can be done?

Exhibit F:

The article suggests that £30 billion would be needed to support the kind of pay deals NHS workers need. From the Open Democracy article, this seems a lot more than necessary – but let’s consider the options it presents anyway:

Earlier this year I noted the suggestion that £30 billion was required to fund appropriate NHS pay deals and wrote a proposal to address the need to finance this, including the possibility that it simply be added to the deficit, which is wholly plausible. As I suggestsed then… this funding could be addressed as follows:

1) £10 billion could come from the additional taxes paid by those lured back to the NHS by better working conditions and higher pay, and by those lured back having given up on work altogether. The impact of the extra NHS spending on growth elsewhere in the economy is also taken into account in this estimate.

2) At least £5 billion might be raised from taxes paid by those able to return to the workforce either because their own conditions will be sufficiently well managed to allow this or because those that they care for will enjoy better health, letting them return to work.

So, at least half of the funding required will be directly generated from the benefits created by that additional spending. Options for the remaining £15 billion include:

3) A government could simply decide to run a bigger deficit to fund the £15 billion requirement. The impact on the national debt is insignificant.

4) The Bank of England currently has a programme of selling the government debt it owns bought under the quantitative easing programmes that paid for the banking crises of 2008/9, the Brexit crisis of 2016 and the Covid crisis of 2020/21. If £15bn of this programme was cancelled each year and bonds to fund the NHS were sold instead the funding to deliver the healthcare we need could be found. In this case, there would be no net impact on the national debt owned by third parties.

5) National Savings and Investments could issue NHS Bonds in ISA accounts to provide the funding. £70 billion is saved in ISAs each year. Properly marketed, it would be easy to find £15 billion a year this way.

6) Halving the tax reliefs on savings available to the wealthiest 10% of people in the UK each year. At present it is likely that this group enjoy at least £30 billion of pension and ISA tax reliefs each year.

7) Since the Public Accounts Committee of the House of Commons has found that for every £1 spent on tax investigations £18 of additional tax is raised, investing £1 billion in additional funding with HM Revenue & Customs might be enough to recover the funds required for the NHS each year.

8) The rate of capital gains tax in the UK is currently set at half the rate of income tax in most cases. If it was set at the same rate as the income tax rate then the revenue from this tax might double, raising £15 billion a year.

Judging by all this evidence, one is left with the inescapable conclusion that the Tory government has wasted huge amounts of money that could have been used to support real investment in the National Health Service, and is claiming there is no money available now.

But in fact there are many options available to it; ministers are simply refusing to consider them.

So the NHS crisis that has led to the strikes by doctors, nurses and ambulance teams was caused by the Tory government, and the Tories are deliberately withholding the cash necessary to restore the system.

It is Tory waste that has caused the problem; the strikers are simply doing the only thing they can do to raise awareness of it.