Overstretched British public hospitals to have funding REDUCED
This is going to mean even more rationing of medical care. More and more sick people are going to be sent home with nothing more than paracetamol
Hospitals will be forced to make cuts to pay for a massive rise in the bills for Labour's controversial private finance programme after the next general election. Whitehall documents seen by The Sunday Telegraph reveal a financial bombshell which will hit the next Government.
The cost of NHS building deals agreed since 1997 will swell by almost one quarter from 2011 to 2014, necessitating billions of pounds in "efficiency savings", which are already being drawn up by trusts.
Economists described the pressures about to hit the health service as "horrendous" while opposition politicians warned that taxpayers and patients were about to pay the price for "financial recklessness on an unprecedented scale".
More than 100 NHS trusts are operating private finance initiatives (PFIs) agreed since 1997. Under the deals, private companies build hospitals and lease estates and services back to the health service over a period of around 30 years. Of a total £60 billion debt owed to the developers, less than £5 billion will have been paid to them by the time of a likely general election next May, the document, disclosed under the Freedom of Information Act, shows.
The contracts allow trusts to build hospitals that they could not afford to pay for outright, with the bills excluded from Britain's public sector borrowing limits, allowing the Government to take on more debt. Repayments during the next spending review period – from 2011 to 2014 – will reach £4.18 billion, almost £1 billion more than current levels, according to the documents, sent from the Department of Health to the Treasury.
The steep increases come as the NHS prepares for its annual budget to be frozen, meaning cuts in real terms as PFI and other costs rise. As a result, hospitals have been ordered by Sir David Nicholson, the NHS chief executive, to make "efficiency savings" of at least £15 billion over the same period.
The Department of Health returns to the Treasury show the £60 billion total cost of the schemes to taxpayers is more than five times the capital value of the buildings. Annual payments will rise from less than £500 million at the last election, in 2005, to £1.5 billion by 2014, peaking at £2.2 billion by 2029.
The deals, which have always been controversial because of their inflated costs, have encountered extra problems in recent years since the introduction of other policies which threaten hospitals' incomes.
Trusts are now given a standard payment for each person they treat, while patients can choose where to be treated. With PFI sites – which cost around 30 per cent more to run than traditionally-financed deals – struggling to protect their income, trusts are axing other services so they can keep paying contractors debts which will run for decades.
Planners in South London and Kent have concluded that of four hospitals battling debts, closures should occur at Queen Mary's Hospital, in Sidcup, because the other three sites – in Lewisham, Woolwich and Bromley – have PFI bills to pay, limiting the scope to cut fixed costs. Despite local protests, the Accident and Emergency unit in Sidcup will be closed, and maternity services downgraded.
Meanwhile, other parts of the health service, which are trying to cut costs by treating more patients in the community, have left other PFI sites in difficulty.
Prof John Appleby, chief economist at leading health think-tank the King's Fund, said hospitals would face "horrendous pressures" when the rise in the amount owed to contractors in the next spending review coincides with the anticipated freeze in the total NHS budget. "Trusts are locked into contracts which run for 30 years or more," he said. "Now that it turns out they were often built on over-optimistic assumptions, the hospitals' hands are largely tied, because PFI is very inflexible. Rises in repayment costs are very likely to mean cuts in services."
Norman Lamb, the Liberal Democrat health spokesman, said that patients and taxpayers were about to reap "terrible consequences" from an act of financial recklessness which he described as "almost unprecedented" both in its scale, and likely impact. "We aren't against the use of deals like PFI per se," he said. "What concerns me is that the Government made a monumental error in relying on these deals on such a grand scale, in deals which were not properly budgeted. "The result is that they have created a straitjacket for the NHS, which will damage services, while creating an economic time bomb which mortgages current and future generations," he added.
The Department of Health continues to defend the use of PFI, but regulators have cautioned trusts about the level of debts they should take on. Guidance issued earlier this year by Monitor, which regulates foundation trusts, says organisations negotiating construction deals will no longer be allowed to take on annual repayments which are more than 10 per cent of turnover – a figure breached by many of the trusts already making repayments on deals.
A spokesman for the Department of Health said: "Thanks to PFI, we have been able to undertake the biggest hospital building programme in the history of the NHS. All PFI schemes must demonstrate that they are good value for money and affordable when compared with the public funding alternative. "The cost to the public sector of undertaking long term capital investment has always been spread over a number of years." He said hospitals were able to treat more patients after moving to new premises, citing the example of Norfolk and Norwich Hospital which now treats 23,000 more patients a year than the buildings it replaced.
Defend green jobs! Smash ungreen jobs!
Environmentalists are defending jobs at the ‘good’ Vestas wind-turbine factory while ignoring the sacking of workers at ‘evil’ Thomas Cook
Currently the dictionary defines double standards as ‘a set of principles permitting greater opportunity or liberty to one than to another’. If any dictionary in the future wanted to illustrate or illuminate that definition, it could do worse than point to environmentalists’ sudden interest in the politics of industrial strife. In Ireland and Britain over the past couple of weeks there have been two dramatic and principled occupations of workplaces by workers threatened with redundancy, yet where one has been widely promoted in the media by green-leaning commentators, the other has been ignored, meaning that its organisers could be hassled, arrested and charged by the cops with little controversy.
Environmentalists have used their not inconsiderable clout in public debate to turn the occupation of the Vestas wind turbine factory on the Isle of Wight into a cause célèbre. When the owners of Vestas announced in July that they were moving abroad, thus making 600 people on the Isle of Wight redundant, 25 Vestas workers occupied the factory and many more protested outside in solidarity. They are effusively supported by greens, who have never much cared about workplace politics in the past. Climate change activists have set up camp outside Vestas; they’ve erected banners saying: ‘Save Vestas, Save Jobs, Save the Planet.’ One commentator says no one should underestimate ‘the importance of the occupation’, which has ‘strengthened the alliance between workers and environmentalists’. Another even compares the Vestas workers – who might ‘save the planet’ – to those earlier generations of Brits who took on ‘Germany’s industrial war machine’ (1).
Meanwhile, another workers’ occupation has been ignored. There has been no environmentalist solidarity, no endless publication of op-eds about its ‘importance’. On Friday last week, the staff of the Dublin outlet of the travel agents Thomas Cook were told that their shop was closing with immediate effect, after the workers and their union had the temerity to organise a public protest against the threat of redundancy. In defence of their jobs, 28 Thomas Cook employees occupied the shop on Grafton Street. But after drumming up little sympathy in mainstream Irish and British media and political circles – but managing to win backing from everyday shoppers and passers-by – the workers were arrested in a dawn raid on Tuesday. Gardai smashed their way into Thomas Cook at 5am, took the arm-linked workers out one by one, and drove them to court where they were charged with contempt for ignoring an earlier judgement telling them to leave the shop (2).
Two recession-related occupations, carried out by risk-taking workers willing to put their liberty on the line to defend their own and each others’ jobs, yet only one is championed as ‘important’ by the environmentalist lobby. Why? It isn’t because the Thomas Cook protest is taking place in Ireland rather than in the British, but equally far-flung, territory of the Isle of Wight; numerous Irish protests have been supported in Britian in recent years. More fundamentally it is because, where the Vestas workers are seen as ‘clean’ and thus worthy of support, the Thomas Cook workers are seen as ‘dirty’ and thus eminently ignorable; where, in the hyperbolic, fact-lite view of green activists, the Vestas workers are ‘saving the planet’ by building wind turbines, the likes of the Thomas Cook workers are ‘destroying the planet’ by facilitating unnecessary cheap-flight holidays abroad for undesirable people who have little regard for foreign cultures and plant-life. These double standards illustrate the coercive element in the widespread demand for ‘green jobs’ as a solution to the recession: a new workers’ divide is being created, in which only those with ‘green jobs’ will be accorded respect and support while those with ‘ungreen jobs’ will be left out in the cold.
Environmentalists’ sudden interest in workers’ rights when the Vestas dispute unfolded was always unconvincing. Normally greens implicitly campaign for people to be thrown out of work. Their demonisation of ‘dirty industries’ has helped to make the workers in those industries vulnerable to redundancy by cynical companies and corporations that frequently dress up downsizing and cost-cutting as an environmentalist measure. In recent years greens have demanded the closure of the Drax power station in North Yorkshire (‘Drax the Destroyer’, they call it), which as well as providing electricity to millions of homes also directly employs 700 people. Greens want Kingsnorth power station in Kent closed down, too, and have protested against the construction of ‘Kingsnorth 2’. Kingsnorth employs around 240 workers and Kingsnorth 2 would provide jobs for 3,000 construction workers. Most loudly, greens have demanded the scrapping of plans for a Third Runway at Heathrow – a project that would create a whopping 65,000 jobs (3).
None of those workers matters, however, because they are ‘dirty’ workers, whose livelihoods are ‘destroying the planet’. It is striking that in their defence of the Vestas occupiers, environmentalists simultaneously denounced the government for continuing to invest in airport expansion and the creation of power-station jobs. The sentiment was: ‘How can you claim to be creating a low-carbon economy when you create unclean jobs in airports but will not subsidise clean jobs in wind-turbine construction?’
This is not about defending workers’ rights in principle and making a universal argument for providing everyone with gainful employment and a high wage; it isn’t even about making a calculated judgement about which industries are productive, and thus should remain open, and which industries are unproductive, and thus might be closed. Instead it is about creating a new moral divide, based on shrill language about Nazi-style threats to the future of our planet, between worthy workers and unworthy workers, between the green and the ungreen, between the good and the bad. Indeed, as one green-leaning writer said in support of the Vestas dispute, this is ‘not just about action to save jobs at a time when unemployment is continuing to rise steeply… Rather it is about the necessity to save jobs which are critical to the wider good for society.’ (4) In short, it is not jobs per se that matter; it is not people’s ability to earn a living and provide for themselves and their families that is important; it is only ‘good’ jobs that should be defended, which are seen as being ‘good’, not on the basis of people’s needs or even industrial productivity, but on the basis of very influential environmentalists’ massively overblown fear of the future in which individuals building wind turbines are seen as ‘saving the planet’ while individuals booking holidays for people are considered the devil incarnate.
Indeed, it is not at all surprising that environmentalists are ignoring the Thomas Cook workers. In smashing into the Thomas Cook shop and taking the workers out so that they can officially be made redundant, the Irish police are only doing what environmentalists themselves have tried to do in recent years. The youthful aristocrats of Plane Stupid – who have cheered the ‘industrial disobedience and workers’ solidarity’ at Vestas (5) – have tried on numerous occasions to shut down Thomas Cook outlets. They have put bicycle locks on the front doors of Thomas Cook shops, alongside posters saying ‘CLOSED for a total rethink’, and have argued that the likes of Thomas Cook workers are helping to destroy the planet by facilitating ‘stag and hen nights [in] Eastern European destinations chosen not for their architecture or culture but because people can fly there for 99p and get loaded for a tenner’ (6). Greens want the state to subsidise ‘green jobs’ at Vestas, while the police action in Dublin can be seen as the logical armed-wing conclusion to greens’ desire to destroy ‘ungreen jobs’ elsewhere.
This creation of a bullshit, pernicious moral divide between good and bad workers is the worst response possible to a recession that is making millions of people unemployed. Neither the Vestas workers nor the Thomas Cook workers should be sacked.
We need planes, trains AND automobiles
Justifying high-speed rail as a way of stopping people from flying is a perverse anti-travel argument.
On Tuesday, the UK transport secretary, Andrew Adonis, announced plans to expand high-speed rail services in the UK. Yet his proposals seem to have less to do with allowing people to travel with greater speed and comfort, and more to do with getting people off planes. Perversely, the Labour government is promoting a transport initiative on anti-travel grounds.
‘For reasons of carbon reduction and wider environmental benefits, it is manifestly in the public interest that we systematically replace short-haul aviation with high-speed rail’, said Adonis. ‘But we would have to have, of course, the high-speed network before we can do it.’ By the end of this year, the government plans to have a published route for a rail line from London to the West Midlands, to be built by 2020 at an estimated cost of £7billion, with a framework in place to expand further north in the future. The high-speed link is part of a package announced in July by Adonis to reduce greenhouse gas emissions from transport by 14 per cent by 2018-2022.
Britain’s only current high-speed link, the 68-mile stretch from the Channel Tunnel on the south coast to St Pancras station in London, is hugely popular. Already, 80 per cent of non-car journeys from London to Paris and Brussels are by rail rather than air. Rail could soon add a major slice of travel to Amsterdam, Rotterdam, Cologne and Frankfurt as high-speed links develop in Europe.
Unsurprisingly, the airlines aren’t keen on Adonis’s proposals. Ryanair boss and anti-green rent-a-quote, Michael O’Leary, was as blunt as ever. On the notion that extending high-speed rail could cut short-haul flights to Europe, he said: ‘It is insane. The only link you have is one highly priced tunnel. People are not going to travel to the UK regions, including the Lake District and Cornwall, on a train that only stops at Kent and London St Pancras.’ O’Leary was only slightly less dismissive of the idea of moving domestic travellers from planes to trains, describing it as a ‘valid alternative if you don’t mind the inefficiency and high cost of rail services’ and complaining that while domestic air passengers currently have to pay £20 in tax to travel from London to Glasgow (where planes have 80 per cent of the market), the government continues to ‘subsidise the shit out of the railways’.
Others were over the moon, if only metaphorically. One anti-flights campaign group said it was delighted by the plan to ‘wipe out the market for domestic flights’ in the UK, declaring that ‘no more Ryanair or Flybe is a good thing’ – even if the UK government is still keen to expand airports, too. It is true, as many commentators have pointed out, that people seem to prefer trains to planes in countries like Spain and France, where such high-speed links have almost wiped out domestic air travel in favour of the train. For example, journeys have doubled on the new Madrid to Malaga line in Spain, while the Paris to Lyon line is so popular that the French government has now got the headache of trying to expand the service from two lines to four. No wonder President Obama has plans to replicate such rail success in the US. Britain, however, is different.
Of course, a high-speed line to Birmingham would be nice, but it would not make a huge difference to journey times (it’s only 120 miles and it currently takes just 90 minutes) and it would have zero impact on air passenger numbers because very people fly such short distances. As transport commentator Christian Wolmar points out, even expanding the line to northern English cities like Manchester, Leeds and Newcastle wouldn’t help because air travel from London to those cities is still a small part of the domestic travel market, or is simply being used as a way of connecting to international flights at those local airports. Only by expanding the high-speed link to Scotland could such a link really make a major difference to journey times and the numbers of people flying - and that could cost £30billion. As Wolmar points out, while there are plenty of good reasons to improve our train network, the environmental case is not one of them.
A north-south line would be good, but it is no solution to Britain’s transport needs. The line would still leave some travel destinations – from Bristol, Exeter and Wales in the west, to Norwich in the east and Aberdeen in the far north – badly served. The likely upshot would be an even-greater concentration of business and population in the major cities of the Midlands and the north, while people elsewhere would look to new airports to enable them to get both to London and to cities further afield.
The problem for the government is that the low-carbon argument will always be trumped by the no-carbon argument. Any form of mechanised travel - even trains - will produce greenhouse gas emissions. So the logical conclusion of making climate change the top priority in transport policy is that it would be better if people didn’t travel at all. As one anti-flying activist put it: ‘Adonis and others were keen to explain that we’d still have to expand all the airports to cater for predicted growth in demand (which is generated by the expansion, but don’t let that spoil anything).’ This argument surely gets things the wrong way round, though, as if airport terminal buildings had a hypnotic effect on people, willing them to fly when they never wanted to before. People have always wanted to travel; new airports, train lines and motorways make it easier to do so. Nonetheless, if we put emissions reduction at the centre of transport policy, the logical conclusion is that it is best not to travel at all.
If our current transport technology creates environmental problems, we need to find solutions to those problems, not stop travelling. For example, while replacing petrol and diesel with biofuel could cause all sorts of problems in the short term with food supply, replacing the much smaller volumes of aircraft fuel with biofuels could be a practical, low-carbon solution. The plans for rail electrification could give us much greater flexibility about how to power trains: coal and gas for now, but nuclear, wind and solar in the future. The no-travel, no-carbon outlook is tantamount to societal suicide.
Obsessing about high-speed rail also misses the point that every form of transport has its strengths and weaknesses. There are all sorts of factors that people take into account when choosing if and how to travel, like cost, convenience, speed, comfort and flexibility. If you want to travel from city centre to city centre, trains are great for journeys of up to three hours. No check-in, no driving, just turn up and let the ‘train take the strain’. For longer journeys, the hassle of air travel is off-set by the speed (and, given the stupendous prices charged on Britain’s railways, flying is usually cheaper, too). For trips to less popular destinations, or where you need transport at the other end, the car is often the best choice.
So, to make Britain a truly mobile society, we need trains, planes and cars, and the best possible infrastructure for all three. And we need a government that is committed to the idea that mobility is a good thing rather than one that puts the brakes on our transport future.
Prime Minister Brown insists Britain is still a Christian country
The message seems not to have got through to the bureaucracy, though
Gordon Brown has insisted that Britain remains a Christian country and defended the right of worshippers to express their faith in public. The Prime Minister claimed the country's values are still based on traditional religious teachings, and said it would be wrong if the devout were forced to keep their beliefs private.
His comments, made in an interview with a Christian radio station, come amid growing concern that public sector employees are being punished for acting according to their faith. A community nurse was suspended without pay for two months after she offered to pray for an elderly woman, while two registrars claim they were forced out of their jobs for refusing to perform civil partnership ceremonies involving same-sex couples.
All NHS staff have been warned they face disciplinary action if they are accused of "preaching" to colleagues or patients, while a proposed EU equality directive has raised fears that religious groups could be sued by anyone who declares themselves offended by their practices.
But Mr Brown, whose father was a Church of Scotland minister, told Premier Christian Radio: "I think the role of religion and faith in what people sometimes call the public square is incredibly important. "In Britain we are not a secular state as France is, or some other countries. It's true that the role of official institutions changes from time to time, but I would submit that the values that all of us think important – if you held a survey around the country of what people thought was important, what it is they really believed in, these would come back to Judeo-Christian values, and the values that underpin all the faiths that diverse groups in our society feel part of."
Asked if he thought it would be better if Christianity were "privatised", he replied: "I think it's impossible because when we talk about faith, we are talking about what people believe in, we are talking about the values that underpin what they do, we are talking about the convictions that they have about how you can make for a better society. "So I don't accept this idea of privatisation – I think what people want to do is to make their views current.
"There is a moral sense that people have, perhaps 50 years ago the rules were more detailed and intrusive, perhaps now what we're talking about is boundaries, beyond which people should not go. "And I think that's where it's important that we have the views of all religions and all faiths, and it's important particularly that we're clear about what kind of society we want to be. "So I think the idea that you can say: 'What I do in my own life is privatised and I'm not going to try to suggest that these are values that can bind your society together', would be wrong."
Asked whether he believed the Government gave preferential treatment to Muslims ahead of other faith groups, the Prime Minister said: "When you've got a society that is diverse, what happens is for a time, the issue is integrating your minorities into that society. And so people want to make sure that people who may feel discriminated against have the chance to get jobs, or get education, or get chances that otherwise they might not have. Then people – rightly, I think – say: 'But what about the integration of your society as a whole – how can people work together, how can you have a more cohesive society'?"
Although Mr Brown often describes himself as a "son of the manse" and said the MPs' expenses scandal offended his "Presbyterian conscience", his new comments are his strongest in recent years on the expression of faith by others. His predecessor, Tony Blair, famously did not "do God" while in Downing Street but soon after stepping down converted to Roman Catholicism and set up a faith foundation in the hope of promoting religion as a "powerful force for good".
British victims of crime failed by justice system, says MPs' report
Victims of crime are being failed by the justice system, which is weighted in favour of criminals, a damning report by MPs has warned. Government claims that victims are at the heart of the system, with prosecutors acting as their "champions", misrepresented reality, the Commons Justice Committee said. Ministers who tell victims that the system is being "re-balanced" in their favour were likely to leave them disappointed, they concluded after an inquiry into the working of the Criminal Prosecution Service (CPS).
Instead, offenders were being charged with lower offences by prosecutors keen to boost conviction rates. Violent offenders, muggers, burglars and sex offenders were escaping prison because the CPS wanted to guarantee a guilty verdict, according to magistrates, police and barristers who gave evidence to MPs. The report attacked the growth in out-of-court penalties as a "fundamental change" to criminal justice. This compared with innocent members of the public given harsh fines for overfilling wheelie-bins or driving in bus lanes, a watchdog pointed out.
The report comes 10 months after Jack Straw, the Justice Secretary, admitted the Government has too often concentrated on the needs of offenders, rather than victims.
The report concluded: "The prosecutor is not able to be an advocate for the victim in the way that the defence counsel is for the defendant, yet government proclamations that the prosecutor is the champion of victims' rights may falsely give this impression. "Telling a victim that their views are central to the criminal justice system, or that the prosecutor is their champion, is a damaging misrepresentation of reality. "Expectations have been raised that will inevitably be disappointed."
The report also quotes comments made by Sir Ken Macdonald QC in his final speech as the Director of Public Prosecutions last year, when he warned "it will never be possible, in adversarial proceedings governed appropriately [by the right to a fair trial] for the interests of victims to overcome those of defendants".
Barristers, police and magistrates all told the committee of concerns that crown prosecutors deliberately bring lesser charges, or no charge at all, to offenders to ensure an easier "less risky" conviction in a target-driven culture. It includes violent offenders being charged with common assault instead of actual bodily harm, muggers being charged with theft from the person instead of robbery or burglars and sex offenders being given cautions rather than facing court and possible jail.
John Thornhill, chairman of the Magistrates' Association, quoted one example when a man was kicked and punched by three men, an offence caught on CCTV, but the culprits were charged with threatening behaviour. He told the Daily Telegraph the concern was whether such moves were "fair on the victim".
Sir Alan Beith, chairman of the committee, added: "Victims often feel like powerless bystanders in the criminal justice system. The Government propagates this idea that the CPS is the victims' champion, but it isn't."
Police officers told the committee some prosecutors were "risk averse" so they could hit conviction targets, while the Magistrates' Association raised the prospect of "plea bargaining by the back door". John Coppen, from the Police Federation, said officers believe the CPS are "reluctant to put before the a court anything other than cast iron cases so better to meet their performance targets".
Peter Lodder QC, chairman of the Criminal Bar Association, added: "We suspect that there has been some under charging. We have reason to suppose that there is a tendency to accept inappropriate pleas."
Stephen Wooler, the Chief Inspector of the CPS, raised concerns over the growth of cases which don't reach court, such as cautions and on-the-spot fines. He warned that in some parts of the country, people who overfill wheelie bins or drive in bus lanes are fined more than those guilty of shoplifting or criminal damage. Residents who overfill their wheelie bins face fines of up to £110, while those driving in bus lanes can face fines of up to £120. Shoplifters face just £80 fines.
He called for a "form of scrutiny" over the ways the powers are being used amid concerns they are "less subject to judicial process". He said: "I am not satisfied that the present level of checks and balances is sufficient to retain public confidence." MPs were told that no further action is taken in a fifth of occasions where offenders breach conditional cautions.
Figures earlier this year showed less than half of suspects in cases considered solved by the police are actually charged or summonsed, with the rest not reaching court. A record 207,500 on-the-spot fines were issued last year.
The report concluded: "The growth in the number of out-of-court disposals represents a fundamental change to our concept of a criminal justice system and raises a number of concerns about consistency and transparency in the application of punishment."
Keir Starmer, the current DPP, said there was "no evidence of over or under charging". He added: "Fair, fearless and effective; open, honest and transparent; protective, supportive and independent: these are the qualities that the public has a right to expect of its public prosecution service. We are determined to meet those expectations."
A spokesman for Baroness Scotland, the Attorney General, added: "The Attorney continues to support the commitment to victims in the Prosecutor's Pledge and the other initiatives the CPS has put in place to support and secure fair treatment for victims and witnesses, including those who suffer from hate crimes. "The CPS has made it clear that its role is to enable, encourage and support the effective participation of both victims and witnesses at all stages of the criminal justice process."