TONY BLAIR himself is forcing on the relentless pace of change in the National Health Service, apparently determined that the process towards privatisation should be established and effectively irreversible by the time he Slallas auwil
The news that the NHS in England ended the year with a net deficit of £512m after taking into account unspent surpluses totalling £765m was used as a pretext for a renewed media offensive stressing the need for Blair's market-style "reforms".
This focus on reorganisation and on a system in which the cash - in Margaret Thatcher's famous phrase - "will follow the patient proved a handy smokescreen to divert many less able journalists from the harsh reality that NHS Trusts this year will need to cut spending and slash services to the tune of £1.3 billion to balance their books.
The scale of this task can be judged by the fact that scaling down the deficits from an estimated £700m to the published figure of £500m has already resulted in the loss of 15,000 jobs, and these figures seem set as more finance directors do their sums.
As we go to press the Mid Yorkshire Hospitals Trust, proclaimed just a week earlier by the Health Service Journal as a brilliant success of "turnaround" management, is to axe 1,000 jobs in its effort to balance the books, while Hammersmith Hospitals Trust in west London seems set to announce 300 job osses ano deo cosures.
Mental health services, too, are continuing to take a hammering as Lambeth and Southwark Primary Care Trusts each prepares to slash £4m from their spending, forcing the closure of beds, specialist care and rehabilitation services in a deprived area of SE London.
Like many of the cuts that have been announced the SE we are still in a period of phoney war in which controversial targets are announced, but few staff if any have yet actually seen their jobs axed: this helps to explain the continued delay in any full-scale trade union fightback.
Union members at Whipps Cross Hospital in NE London have been among the few who have taken pre-emptive action with a militant lunchtime protest at the threat of up to 400 job losses.
Elsewhere the union has not yet been able to implement its promise to ballot for action if any health workers face compulsory redundancy.
The reality is that while the cutbacks so far announced are bad enough, ministers have been urging local NHS managers to push through even more "tough choices", closing whole hospitals. It is already very clear that this is a policy that would trigger wholesale local resistance.
Any Labour MP endorsing a hospital closure could expect to share the fate of the one-time member for Wyre Forest, David Lock, who unwisely put his name to the closure of in-patient care at Kidderminster Hospital and was promptly booted out.
However NHS managers are not elected, and the PCTs and Trusts are quango bodies that do not have to answer to the local electorate, so as Trusts begin to find themselves struggling to balance their books, they may be inclined to put financial issues ahead of accessible patient care.
This is a special concern in hospitals and departments which stand to lose out under the experimental new tunding formula which the government imposed upon NHS Trusts from April.
The "payment by results" system pays only a fixed nationally-determined fee for each item of treatment delivered: so if patients opt to seek treatment in other NHS hospitals, their local Trust loses the funding: where patients opt to use a private treatment centre, the funding follows the patient out of the NHS.
But for many hospitals where current costs exceed the fixed tariff, they face making a loss with each patient treated - or a drastic cost-cutting operation or closure. Ironically the biggest losers will be Private Finance Initiative (PFI)-funded hospitals because of their much higher overhead costs.
That's why the Keep Our NHS Public campaign has consistently stressed the need to combine the fight against cuts and closures in the NHS with the fight against privatisation and the ludicrous costs of PFI and the use of private management conSullals
Blair has made clear he is not backing down: it's up to campaigners to step up their act in readiness for a hot summer and autumn of cuts and privatisation. • www.healthemergency.org.uk • www.keepournhspublic.com