The nurses are on strike today. In the usual way that people speak to very small children the government has told them they can have a 1% pay rise or something else but not both because Mummy and Daddy can’t afford it.
So far as I’ve seen, nobody in government, the press or officially, the health unions has stood up and called this the utter horseshit that it is, that if a government can increase ‘the deficit’ and call it reducing it and at the same time commit to an endless war against abstract nouns when it doesn’t even know who’s on which side, assuming there even are any sides, then clearly it can afford anything it wants to.
But that’s unsayable. As Goering pointed out at his inevitably-decided trial at Nuremburg, the kind we should have had in 1997 except we didn’t know then we’d just voted in the same thing but with more hand-movements and a smile, it’s easy to get people on side with the idea of a war they don’t want. You just call them traitors if they say anything against it and tell them the enemy (anybody, it’s never really mattered, take your pick) wants to rape their dog and take away their iPad so they can’t watch X-Factor. Or the contemporary equivalent. And it always works, because it takes a bit of an effort to find out the truth and dogs and iPads don’t pay for themselves and there’s stuff to do.
Another truth that is a bit hard to find out because the media themselves are a bit too busy to mention it is that there will never be an NHS privatisation bill. There doesn’t need to be. It’s already been done.
For the last six months I’ve been working for the NHS, at a mental health Foundation Trust. It was supposed to provide services to two large rural counties to help people in fragile and damaging states of mind. Effectively now, it can’t, by design.
The first project I worked on was to provide a drug and alcohol service for around one and a half million people. We calculated what it was going to cost to provide it, working on the NHS overhead figures which usually come in between 20% and 25%. It pays for things like training, pensions, and all the expenses you can’t get rid of, such as the maintenance of buildings that have had to be shut almost as soon as they were opened, because there isn’t the money to run them. I can show you two, boarded up and unused as one of them has been since the last brick was laid. The maintenance building is closed now as well, so anything that needs doing won’t be done by the NHS and will have to go out to tender.
We thought somebody like SERCO would bid for the Drug & Alcohol work, along with other NHS Trusts from other areas. We thought SERCO would put in a bid at about 70% of our own NHS bid, because SERCO can afford to do that, operating on an overhead margin of 6%. Of course, SERCO don’t have to pay for training, or full-time staff and quite often deliberately underbid to get the work, as they did when they provided GP cover in Cornwall, where SERCO felt one GP was enough to cover the entire county some nights, and if that wasn’t really quite enough they’d falsify the records to make it unhappen anyway. Which is why SERCO is facing multiple different counts of criminal fraud. Which is not why SERCO is barred from pitching for any further NHS work, because it isn’t. This behaviour is entirely acceptable and in no way will or even can count against any further bids SERCO put in. Because that’s the system you voted for, especially if you didn’t vote.
None of it mattered anyway, because when we got the official budget from the county council which has the statutory duty to provide these services and can’t, so they contract them out to the NHS or anyone else who fancies a go, the money available was just over half the amount the NHS thought would be needed to do the job. So the NHS didn’t bid, because it couldn’t do the job for that money. Someone who thinks they can will be doing it instead. The NHS budget Cameron was talking about wasn’t even relevant. Any journalist could have found that out, if they’d wanted to. They just didn’t want to. This was County Council money. This is how it works.
Obviously, whoever gets the contract won’t be providing training or pensions or standard terms of employment or company cars or even minibusses to get staff from one end of a poorly served hump of land jutting out into the North Sea with hardly any trains and busses about as rare as a Labour voter around here. Because the NHS is safe in the Conservatives hands. They’ll take good care of it. So that when the last service the NHS currently does is put out to tender, when more staff have left, when the last bid can’t even be pitched for because it simply can’t be done for the money the local authority thinks is a perfectly reasonable amount, all that lovely prime development land on the edge of the town can be sold, mature trees, bus stop and all mains services connected.
Buyers are advised to carry out their own surveys and advertised services may not actually work, obviously. But that’s not really the point, is it? Nobody’s interested in how the NHS operates or what works and what doesn’t. You shouldn’t even be asking questions about it. Can’t you see the enemy are making you think that way? What are you, some kind of ISIS apologist?