No jobs? Let them have prizes!
nick cowen, 7 March 2007
The NHS remains in crisis. More catastrophes barely make an impression on the British public. They no longer seem to make a difference: the NHS limps on with the efforts of the doctors and nurses that still treat medicine as a vocation. Some targets are hit, others are missed, and amid the crushing burden of admin and the monthly crop of scandals, hospitals and surgeries force through some limited health provision.
In this context, the challenge is trying to get some limited grasp of where the current disasters are making their impact and how they are related. A central problem is the deficit, an issue imposed on the NHS by Whitehall. Strictly speaking, the notion of a deficit is a fiction, a term borrowed from commerce. Its application in this instance, and Patricia Hewitt’s promise to ‘balance the books’, is rather peculiar as there is no ‘income’ to match the outgoings other than the budgets set by the Department of Health. This is not ‘book balancing’ at all but rationing by another name. The centrally rationed level of provision can only mean service cuts and job losses. The fact that the rationing is enforced through annual balance sheets merely creates the perverse outcome that it is towards the end of a financial year that the public should avoid getting ill at all costs.
This makes this promise to ‘balance the books’ simultaneously the most artificial and most destructive ‘target’ ever set by this government to measure its own performance. The test that Hewitt has set for herself is not to achieve a basic level of service provision but to conform to an arbitrary level of financial efficiency (set ultimately by the treasury). Services can be delayed and individuals can die, so long as that performance indicator is hit later this year.
Disastrous as this is, we have barely even started. This ‘deficit’ (which in February stood at £1.3 billion), artificial and arbitrarily set as it is, could have been paid for several times over if the government’s IT projects for the NHS had not opened up an entire extra flank of destruction. The current Private Eye has an in-depth report on the costs of the national database of patient records (SPINE), the ‘choose & book’ system designed to offer choices of hospital for patient referrals and hospital administration systems. SPINE has not been implemented; the other schemes are barely functional. The cost is an astronomical £12.4 billion
Worse than the waste of a failed IT system, is when a new system was successfully implemented! The Medical Training Application System (MTAS) is that success and under the revolutionary Modernising Medical Careers (MMC) scheme has required both new and current junior doctors to re-apply for posts in their specialism. The move from doctors applying with CVs directly to available vacancies has been replaced by a central system designed to offer applications according to a standard set of procedures, dictated centrally.
The sudden glut of applications caused by forcing doctors already in posts to re-apply leaves up to 8,000 qualified junior doctors without any job offers at all who now face unemployment, work overseas or finding another occupation. The government has admitted this has become a fiasco, but the promised inquiry they have announced won’t offer much condolence to currently unemployed doctors.
Meanwhile, doctors might be eligible to apply for another NHS job: lead associate at the health and social care awards. This pays rather well compared to many NHS jobs. Considering this, and the government’s new-found commitment to complementary medicine, merely describing the government’s attitude as misguided doesn’t quite cut it. The only reasonable analogy to the government putting on lavish awards ceremonies and providing foot massages on the NHS while hospital wards are being shut down is that of Nero singing while he watches Rome burn.