Ministers have got their sums and their timing badly wrong as they prepare to face the electorate claiming a further mandate to "modernise" the
While spending on the NHS this year, at £67 billion, is running at twice the level that Gordon Brown inherited from the Tories in 1997, waiting lists have been drastically reduced along with waiting times, and the equivalent of more than 270,000 additional doctors, nurses and support staff have been added to the payroll, the bad news stories keep hitting the headlines in the hostile Tory press.
And one story has been a gift to the Daily Mail and the Times which have always been the most singleminded and vicious in opposing the principle of the NHS and promoting alternative, even more privatised options: many Trusts are in worse financial straits today than they have ever been.
Estimates of the total of unresolved deficits among hospital Trusts in England alone range from £200m to £500m in March 2005, leaving dozens of Trusts to carry debts of £10m or more into a new financial year.
Some are already making cuts - closing beds and operating theatres and cutting down on the use of costly agency staff and overtime to fill vacant posts: but many of these cuts are falling far below the level needed to balance the books and many more are holding fire on much heavier cuts until after the expected May 5 Election.
The strangely relaxed attitude of the Department of Health to the spectacle of dozens of Trusts and many Primary Care Trusts (PCTs) failing by miles to hit their financial targets, can be directly explained by the imminence of the Election.
For exactly the same reason ministers staged a tactical withdrawal from their plans to torce through the new "Payment By Results" (PBR)
which should be financing 70% of NHS treatment from April 1 - but which threatens to push dozens of hospital Trusts and even more specialist departments over the edge, triggering wholesale cuts and closures, if Blair wins his coveted third term.
Hospitals which are struggling to cope with demand will be penalised if they treat fewer patients than planned, and only paid for the work they do: well-resourced hospitals which successfully "poach" patients from elsewhere can pocket the difference.
That policy has been diplomatically put on the back burner until 2006, when the carnage will begin: some doubt that the full policy will ever be rolled out for fear of the consequences in terms of the closure of busy local hospitals.
Although PBR rules out competition on the basis of price, with the phased introduction of Department of Health reference prices for specific treatments, competition for contracts is set to be fiercer than ever once the PBR system is phased in.
Ministers clearly want to build up sufficient capacity in the private sector to generate a real fear that failing NHS Trusts will be allowed close down, with services delivered from alternative private Ministers clearly want to build up sufficient capacity in the private sector to generate a real fear that failing NHS Trusts will be allowed close down. providers. The PBR system helps New Labour break down the barriers between the public and private sectors, and switch more work to private sector providers.
This is no longer an "internal" market, but simply a market system. NHS Trusts therefore have increasingly to compete not only against other NHS Trusts, but also against private hospitals which have a much more selective -and thus much less complex and costly - caseload, with no emergencies.
Bizarrely, NHS hospitals, under the cosh to deliver endless year-on-year "efficiency savings" have been told they will be allowed to spend taxpayers money advertising to attract patients.
And the pace of this competition has been forced by putting the responsibility not on to Primary Care Trusts, but on to individual patients, who will be offered a progressively wider "choice" of where to have their treatment.
By the end of 2005 Primary Care Trusts will be obliged to offer almost all patients a "choice" of providers including at least one private hospital - from the time they are first referred: but eventually (from 2008) Blair has pledged that any patient will be allowed to choose any hospital which can deliver treatment at the NHS reference cost.
Early in 2005 the government invited private tenders to deliver a further 250,000 operations a year, worth an estimated £500 million annually: in addition another £400m worth of X-rays, scans, blood tests and pathology tests will be hived off to the private sector.
These moves will almost double the number of private sector operations to be purchased by the NHS, pushing the government's total spend in the "independent sector" up towards €1.5 billion - two thirds of the total £2.3 billion turnover of the private medical industry in 2003.
An underlying difficulty for those arguing in favour of
greater 'partnership' between the public and private medical sectors is the chronic and worsening shortage of suitably skilled professional staff, all of whom in Britain are trained by the
The relatively small scale of private medicine and the long-standing under-occupancy of private hospital beds has meant that any additional caseload diverted from the NHS to private hospitals must result in intensified competition to recruit and retain nursing and medical staff.
Health Secretary John Reid now insists that patient choice is a more fundamental principle than maintaining local access to NHS hospital services, following a line from IS our principles"
What this scenario does not address is the wide range of emergency and other services which are currently available only from NHS hospitals, and which the private sector has shown no interest in providing. NHS Trusts will have to close services which attract too few patients, and the NHS Bank has been told to stand by and offer "support to services in transition, where exit or recovery is needed".
The government's scenario also assumes that all NHS hospitals will become "foundation Trusts", free-standing public corporations, by 2008: but the scale of the financial problems rife among Trusts suggests this may be a vain hope.
After waving through a first wave of applicants with minimal financial scrutiny, this year the Regulator (Monitor) has so far rejected four out of nine applications in January and five out of eleven in March on the basis of concerns for their financial viability - presumably to avoid further embarrassment along the lines of the financial crisis in the first-wave Bradford Hospitals Trust.
It appears that few of the Trusts with two stars or fewer will stand much chance of passing this new financial LCOL.
The full financial reforms are not the only measures postponed to avert pre-election disaster. Another conspicuous retreat has been the hugely unpopular plans to slash NHS pension entitlements, increasing the retirement age for anyone due to reach 60 after 2013, and for all new staff joining from 2006.
Under threat of coordinated strike action from public sector unions, Blair personally intervened to postpone this onslaught until after the votes are counted.
As we plunge into another new year of cash crisis and runaway deficits, with both of the potential governing parties pledged to expand the private sector and squeeze the NHS, there don't seem to be many good options for health workers.
But perhaps the impact of the threatened pensions strike gives a clue: coordinated and militant action to challenge job cuts, closures and privatisation may be the only way to save the NHS as a public service, and defend standards of care for patients. Where has all the money gone? What has gone wrong on the NHS financial front? The problem is that the extra cash injected by Gordon Brown since 2000 eventually came through in the aftermath of two decades of cuts and deficits which had destabilised Trusts - and came with a web of strings attached.
Much of the new money had to go straight back out to hire more staff, often also agency and bank staff, to enable services to expand and reduce waiting times - to meet tough new government targets.
Billions more have been siphoned straight out of the NHS to buy tests and waiting list treatment from private hospitals and clinics - and Blair has set the target for 10% of NHS elective operations to be carried out in private hospitals this year, rising to 15% by 2008 - regardless of the impact this will have on hard-pressed NHS hospitals, which will lose not only cash, but vital staff, to private hospitals and treatment centres.
NHS Trusts have been forced into carrying out more work than they are funded for - and then saddled with forking out the unfunded difference to pay for the new consultants' contract and Agenda for Change.
Others have been dragged into costly PFI schemes which "ring fence" the bill for support services and leave hospital chiefs seeking cuts in clinical care.
And all the time private sector suppliers, including drug companies, have been squeezing up prices, far faster than inflation.
For every E1 spent on staff in 1995, just 71p was spent on goods and services from the private sector: but by 2003, for every E1 spent on staff £1.14 was spent on 'procurement - an increase of over 50%. Over this same period NS output increased by 28%: the rest went into shareholders pockets.
page 9 of the scan
Tony Blair famously said in 1997 that his priorities were, education'. In March this year he said, class-divided hierarchy of different types of schools.
Private schools are providing gourmet education for the rich.
Labour's latest policy, set out in the 14-19 White Paper, represents the explicit abandonment of the vision of a workplaces will follow a workrelated curriculum dictated by the employers. As the White Paper says, 'Crucially, we intend to put employers in the driving seat.
Labour has no interest in helping students to acquire the sort of knowledge and