Man with no shame Sir David Nicholson is partly to blame for Mid Staffs- Jeremy Hunt

The man with no shame- Sir David Nicholson does “bear some responsibility” over the scandal at Mid Staffs hospital according to  Jeremy Hunt.Man with no shame Sir David Nicholson is partly to blame for Mid StaffsSpeaking in the Commons during a debate on NHS accountability, Mr Hunt, the Health Secretary, became the most senior Government figure to admit that Sir David, the NHS chief executive, was partly at fault for the failings that led to Mid Staffs, where up to 1,200 patients died needlessly.

It comes after it emerged that senior Government figures are considering a plan for Sir David to “pre-announce” his retirement.

Sir David would then step down later this year or early in 2014, having managed the NHS through the first months of major Coalition reforms starting next month

Sir David is under intense political pressure over the Mid Staffs hospital scandal. A public inquiry into Mid Staffs led to calls for his resignation.

David Cameron has backed him to remain in his post, and this week sent him supportive text messages, sources have disclosed.

Mr Hunt attempted to divert some of the attention away from Sir David by insisting the he does not bear “personal” for Mid Staffs and that the deaths there would have happened with or without the NHS chief overseeing the trust.

Speaking at a debate in the Commons on NHS accountability, Mr Hunt said that Sir David has “apologised” and that he has “been held to account”.

“David Nicholson has been the focus of much attention and as a manager in the system that failed to spot and rectify the appalling cases of Mid Staffs he does bear some responsibility,” Mr Hunt said.

“He said himself, ‘We lost our focus’. He’s apologised and been held to account by this House and many others.

“But I don’t believe that he bears total responsibility or indeed personal responsibility for what happened.”

Attempting to shift the focus of blame onto Labour ministers, Mr Hunt insisted that Sir David had warned figures in the last government that the “target” culture in the NHS was dangerous.

“He was at the SHA [strategic health authority] for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one.

“And he consistently warned both ministers and managers the dangers of hitting the targets and missing the point. It is just not true that if there had been no David Nicholson at the SHA there would have been no Mid Staffs.”

Sir David is said to be resisting pressure to make some sort of concession to his critics by announcing his resignation.

However, there is a growing feeling among ministers and officials that he will have to make some sort of statement about his future.

Several ministers are known to believe that Sir David must go, and even others who sympathise with him believe his departure is inevitable.

From:  http://www.telegraph.co.uk/Sir-David-Nicholson-is-partly-to-blame-for-Mid-Staffs-Jeremy-Hunt

NHS Stafford Hospital- Francis Report blames no one and everyone

In the aftermath of NHS Stafford Hospital report by Robert Francis QC- there seems a huge contradiction- it blames everyone and yet at the same time no one is singled out for the hundreds of needless deaths.NHS Stafford Hospital- Francis Report blames no one and everyoneJeremy Hunt, the Health Secretary, said it felt “wrong” that no one had been brought to book, while David Cameron said doctors should have been struck off.

Julie Bailey, who set up the pressure group Cure the NHS after her mother died at Stafford and was instrumental in exposing the failures, said: “We want resignations. We have lost hundreds of lives within the NHS, we want accountability.”

She said Sir David Nicholson-  the chief executive of the NHS, who was in charge of a body that had oversight of Mid Staffs for part of the time when the deaths were occurring, was “a bully” who should not be in charge of the NHS.

She also called for the resignation of Peter Carter, the general secretary of the Royal College of Nursing, which had told a whistle-blower at the hospital to “keep her head down” rather than fight for change. She added: “We want everybody who knew about this disaster to be held to account, otherwise nothing will change in the NHS.”

James Duff, whose wife Doreen died after receiving sub-standard care at Stafford Hospital, said: “Not one person has lost their job over this – instead they have been promoted and some people have been moved sideways. This has been a disaster yet nobody is accountable.”

The public sector union Unite said Sir David’s position was “untenable” as he was “not the person to lead the NHS into the world of patient-focused care as outlined by Robert Francis”.

Sir David was chief executive of Shropshire and Staffordshire Strategic Health Authority, with oversight of Mid Staffs, for a nine-month period in 2005-06 when the first instances of mistreatment and neglect are believed to have taken place.

Katherine Murphy, the chief executive of the Patients Association, said the report was a “watershed moment” for the health service.

She said: “It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.

“It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability.”

Among the Francis Report’s 290 recommendations were the need for NHS hospitals to put “patients first, not numbers” and a “zero tolerance” approach to poor standards of care.

Health workers should have a “statutory duty of candour” and the obstruction of this duty should be a criminal offence, while gagging clauses preventing staff from raising concerns should be banned.

Ed Miliband, whose Labour party was in power as the Mid Staffs scandal unfolded, also apologised, but said the scandal was “not typical” of what happened in NHS hospitals up and down the country.

3,000 more patients have died needlessly in NHS hospitals

More than 3,000 people may have died unnecessarily at five NHS trusts in a crisis that could dwarf the horrors at Mid Staffordshire, which were detailed in a devastating report published yesterday.3,000 more patients have died needlessly in NHS hospitalsAn investigation began on Wednesday night into excessive mortality rates at the five trusts – the same warning sign that exposed the needless deaths of up to 1,200 patients at Mid Staffs.

The trusts in Lancashire, Essex and Greater Manchester have been “outliers” on an index of expected death rates for two successive years to 2012.

Within hours of the publication of a report which described the “disaster” at Mid Staffs as the worst scandal in the history of the NHS, the Department of Health released figures which raise the possibility that the “appalling” lack of care may still be going on at hospitals around the country.

Between July 2010 and June 2012, a total of 3,063 deaths were recorded at the five trusts, which comprise eight district general hospitals, over and above what would be expected. The worst figures were recorded at Blackpool Teaching Hospitals, where there were 879 excessive deaths. East Lancashire Hospitals NHS Trust, which has premises in Blackburn and Burnley, had 618; Colchester Hospital University Trust in Essex had 599; Basildon and Thurrock, also in Essex, had 508 and Tameside, near Manchester, 459.

Sir Bruce Keogh, the medical director of the NHS Commissioning Board, will be in charge of the investigation in the five areas, where patients and their families have been warning for years that care was inadequate.

The figures piled more pressure on Sir David Nicholson, the chief executive of the NHS, who was already facing demands to resign over his failure to root out the problems at Mid Staffs.

Professor Sir Brian Jarman, an international authority on hospital performance, said he warned the Government in early 2010 about high death rates at four of the hospitals now under investigation. Sir Brian, a former president of the British Medical Association, said problems in the NHS have been ignored for too long and called for Sir David to step down.

“I think he should go,” he said. “The Francis Report [into Mid Staffs] is very good but the difficulty is the same people are running the NHS and the mechanism of denial is continuing.” Earlier, Robert Francis QC published his findings following a 31-month public inquiry into deaths at Mid Staffordshire NHS Foundation Trust, in which he catalogued the “harrowing” experiences of patients at Stafford Hospital.

The report says there was “a failure of the NHS system at every level” to detect problems and take action. Despite between 400 and 1,200 people dying needlessly, and despite five investigations including Mr Francis’s £13  million public inquiry, not one person has been sacked or struck off.

Mr Francis said conditions of “appalling care” flourished because managers “put corporate self-interest and cost control ahead of patients and their safety”. He said patients were “let down” by a “lack of care, compassion, humanity and leadership”, with patients having to relieve themselves in their beds because no one would take them to the lavatory, others drinking water from vases because they were not given drinks and “callous indifference” to their suffering by ward staff. Staff who tried to raise concerns were ignored, bullied or intimidated, and watchdog bodies failed to react to repeated warnings.

Stafford Hospital- hiding mistakes should be criminal offence- Francis inquiry

NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.Stafford Hospital- hiding mistakes should be criminal offence- Francis inquiry Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.

The “appalling” levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.

They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.

But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.

He made 290 recommendations, saying “fundamental change” was needed to prevent the public losing confidence.

His report comes after the families of victims have voiced anger that no-one has been sufficiently punished for their roles.

Senior managers were able to leave the trust with little sanction, while most doctors and nurses involved have escaped censure from their professional regulators.

Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.

He said he was “truly sorry” for what happened at Stafford Hospital, which was “not just wrong, it was truly dreadful” and the government needed to “purge” a culture of complacency.

Mr Cameron said a full response to the inquiry would follow next month, but he did immediately announce that a new post of chief inspector of hospitals would be created in the autumn.

The final report contains 290 recommendations over nearly 1,800 pages. In particular, it recommended:

  •     The merger of the regulation of care into one body – two are currently involved
  •     Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
  •     Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
  •     A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
  •     An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors

While it is well-known the trust management ignored patients’ complaints, local GPs and MPs also failed to speak up for them, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital’s management and national regulators were not challenging enough.

Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.

The Department of Health was also criticised for being too “remote” and embarking on “counterproductive” reorganisations.

Instead, it urged everyone from “porters and cleaners to the secretary of state” to work together to shift the culture and adopt a “zero tolerance” approach to poor care.

Mr Francis said: “This is a story of appalling and unnecessary suffering of hundreds of people.  They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”

He said the public’s trust in the NHS had been “betrayed” and a change of culture was needed to “make sure that patients come first”.

Stafford Hospital- the scandal that shames the NHS PT2

For those whose relatives were deprived of care and even food and drink at the Stafford Hospital it was difficult to understand why there were so few nurses to tend to patients.Stafford Hospital- the scandal that shames the NHS PT2They could little imagine that in August 2005 in the hospital trust’s executive offices, a board led by Martin Yeates had decided to embark on cost-cutting plans as it attempted to secure “foundation trust” status.

Foundation hospitals were a flagship policy for Labour, supposedly the best in the country, and given many freedoms from Whitehall, including over executive pay, and holding board meetings in secret.

The trust needed to convince Monitor, the regulators, that it could meet key targets, particularly the four hour wait, on a lower budget.

The NHS trust was desperately short staffed, with 100 vacancies for nurses alone, but from 2005 onwards it embarked on widespread job cuts. Between 2006 and 2008 160 nurses left the trust either through retirement or redundancy; £1.3 million was spent on redundancy payments.

The board’s obsession about the project left executives blind to the impact cuts would have on patients.

Wards became more reliant on unqualified and untrained healthcare assistants, employed at much lower cost than nurses. On one floor of the hospital, the staff shortages became so extreme that two nurses were left to care for 40 patients.

West Midlands strategic health authority, which had responsibility for supervising the hospital, commissioned which took more than a year to decide – wrongly – that the flaws lay with the data not the care being given by the hospital trust.

As a result no action was taken to examine the actual quality of care at the hospital. In July 2008, a month after the report on the figures was produced, the authority’s chief executive, Cynthia Bower, was promoted to run the Care Quality Commission (CQC), which would be given oversight of all health and social care in England and Wales.

By now, the trust’s bid for foundation trust status had been approved in June 2007 by Andy Burnham, then a junior health minister.

The authorisation was made by one regulator – Monitor, which is responsible for foundation trusts – without being told that another regulator, the Healthcare Commission, later replaced by the CQC, was poised to announce a full scale investigation of the trust, because of its concerns.

It was another year, before, in March 2009, the scandal was finally exposed. By now, Mr Yeates, the chief executive of the trust, and Toni Brisby, its chairman, had already quietly stepped down.

The investigation into Stafford found that failings were such that between 2005 and 2008, there were between 400 and 1,200 “excess deaths” – in other words, up to 1,200 more people died than would have been expected at a hospital with a similar catchment area.

In the regulator’s last act, Sir Ian Kennedy, the chairman of the Healthcare Commission, described the findings as “appalling” – the worst that the regulator had ever uncovered.

Gordon Brown, then prime minister, said that what went on was “inexcusable” and a plethora of reviews and inquiries were announced – but crucially, not a public inquiry to establish how the systems supposed to supervise hospitals – the health authorities, and a labyrinthine regulatory system – failed so catastrophically.

In opposition, the Conservatives called for such an inquiry, which was also demanded by patients’ group Cure the NHS and by a campaign led by this newspaper.

On 9 June 2010, just a month after the Coalition was formed, Andrew Lansley, then health secretary, announced that a public inquiry would go ahead, and now its findings are about to be sent to Jeremy Hunt, his successor.

From:  http://www.telegraph.co.uk/Stafford-Hospital-the-scandal-that-shamed-the-NHS

Stafford Hospital- the scandal that shames the NHS PT1

The scandal at Stafford Hospital shames the National Health Service.Stafford Hospital- the scandal that shames the NHSHundreds of hospital patients died needlessly. In the wards, people lay starving, thirsty and in soiled bedclothes, buzzers droning hopelessly as their cries for help went ignored. Some received the wrong medication; some, none at all.

Over 139 days, the public inquiry into the Stafford hospital scandal has heard testimony from scores of witnesses about how an institution which was supposed to care for the most vulnerable instead became a place of danger.

Decisions about which patients to treat were left to receptionists, inexperienced junior doctors put in charge of critically-ill patients, and nurses switched off equipment because they did not know how to use it.

By the time the hospital’s failings were exposed by regulators, in 2009, up to 1,200 patients had died needlessly between 2005 and 2008.

It happened in simple terms because managers attempted to cut costs and meet Labour’s central targets, so they could achieve the coveted “foundation status” for Mid Staffordshire NHS trust – enforcing 160 job cuts as they tried to succeed.

Now a public inquiry, which opened more than two years ago, is attempting to address fundamental two questions. How was it that the regulatory and supervisory systems which should protect all patients failed so catastrophically – and what is to stop it happening again?

Mr Francis and his team have heard from 290 witnesses, and considered more than one million pages of evidence, in an inquiry which has so far cost almost £13 million. Repeatedly, the evidence has led to one question – whether a “culture of fear” means that the demands of the NHS hierarchy take precedence over the most basic needs of patients.

The inquiry heard that at Stafford, NHS targets ruled supreme.

Orders were cascaded down the management hierarchy, from the executive board, to the operational managers, to the senior nurses and matrons; nurses and doctors who failed to meet them were threatened with the sack.

It led to junior nurses and doctors abandoning seriously ill patients to treat minor cases who were in danger of breaching the four hour Accident & Emergency (A&E) waiting time limit.

For the same reason, patients were often moved out of casualty soaked in urine or covered in faeces, because the target – to admit or discharge patients within four hours – was under threat.

Meanwhile, nurses were instructed by senior nurse colleagues to falsify waiting times, and to claim that patients had been seen more quickly than they were.

Often, patients who were approaching the time limit were put in a clinical decision unit – a “dumping ground” where they received inadequate care, but which allowed nurses to claim that the target had been achieved. An emergency assessment unit was frequently misused for the same reason, becoming so chaotic that staff nicknamed it “Beirut”.

NHS managers staffed the hospital so thinly that there were never enough consultants to properly supervise junior doctors, who took much of their instructions from the senior nurses and matrons who enforced the targets.

At nights it was worse. After 9pm, the most senior surgeon left in charge was often a junior doctor, with little experience of emergency surgery.

Many of the nurses had never been shown how to use basic life-saving equipment, such as cardiac monitors, which identify whether a patient is deteriorating; some turned them off.

When patients arrived at A&E, there were not enough nurses to assess them. In fact, the task was left to receptionists, who took decisions based on a “gut instinct”.

Labour planned profit making NHS exports two years ago

Labour began selling NHS services overseas two years ago despite today condemning the Coalition’s plans to set up profit making hospitals abroad, official documents show.Labour planned profit making NHS exports two years agoThe labour party is facing accusations of hypocrisy after saying the Government”s decision to export NHS expertise is an example of David Cameron’s “rampant commercialisation”.

Andy Burnham, Labour’s shadow health secretary, called on the Prime Minister to “get his priorities right” and concentrate on the NHS at home, rather than chasing profit abroad.

However, it has now emerged that Gordon Brown’s government set up a profit-making arm called NHS Global to “maximise its international potential… and bring benefits back to the UK taxpayer”.

Its purpose was to “market valuable assets across the system overseas, ranging from innovative products and professional expertise to provision of NHS services and treatments”.

Anne Milton, the public health minister, accused Labour of “campaigning against its own policy”

“Andy Burnham has jumped on every passing bandwagon – now he is attacking the ability of hospital doctors to raise money for NHS patients,” she said. “It is clear that Labour will stop at nothing to score a political point, even if it means damaging patients.”

The Coalition plans to set up a new body called Healthcare UK to capitalise on the good name of the NHS, which was promoted all over the world during the Olympic opening ceremony.

It will encourage hospitals to set up profit-making branches abroad to raise funds for patients at home and raise the international profile of the health service.

Critics said the Government should be concentrating on the huge challenges facing the NHS at home, rather than abroad.

David Stout, deputy chief executive of the NHS Confederation, insisted the plan would not “divert attention away from local health services”.

It is “absolutely right” to charge for NHS services abroad and bring back the profit to help improve patient care in Britain, he said.

Mr Stout said the idea of setting up foreign branches of well-known hospitals, such as Great Ormond Street and the Royal Marsden, is a huge opportunity as long as services in the UK are not harmed.

He added: “I don’t think this is distorting what we offer UK citizens, this is about exploiting the brand internationally.”

He said any profits would be “marginal” in the scheme of the NHS’s £100 billion budget but the health service should do everything it can to “help UK Plc”.

Officials from the Department of Health and UK Trade and Industry will launch the joint scheme this autumn, which will aim to build links between hospitals wishing to expand and foreign governments which want access to British health services.

The proposal was reportedly inspired by hospitals in America, including Baltimore’s John Hopkins, opening similar branches abroad.

From: http://www.telegraph.co.uk/Labour-planned-profit-making-Brand-NHS-two-years-ago

Hinchingbrooke NHS hospital privatisation shows what private companies can do for the National Health Service

The success of Hinchingbrooke NHS hospital privatisation is a coup for the supporters of innovation in the National Health Service, says Chris Skidmore MP. Hinchingbrooke NHS hospital privatisation shows what private companies can do for the National Health ServiceNews that Hinchingbrooke hospital, the first NHS hospital to be run by a private company, has seen remarkable improvements in the last six months, seems to have passed almost unnoticed by the media.

Cautious optimism is the correct approach to take, but the news of falling waiting lists, higher quality service and greater efficiency should be welcomed by all.

It is, in particular, a victory for those who have backed reform and innovation in the NHS to ensure that the service remains world-class and sustainable, and a massive setback for Labour’s doom- laden, opposition-for-opposition’s-sake approach that has gone so badly wrong for Andy Burnham.

Indeed, Burnham has managed to be on the wrong side of the argument at every possible stage.

When Circle took over Hinchingbrooke, he claimed that the decision “has worrying implications for the future of our NHS” and has remained highly critical of the move ever since. One would have thought that he would want to play up the fact that Labour initiated the tendering procedure whilst he was Secretary of State.

The truth is however, that to praise the remarkable turnaround would be to admit that he and his party’s two years spent opposing all NHS reform have been utterly wasted.

So what are Circle doing right? They took over a hospital with £40 million of debt, under a new arrangement that would allow them to take the first £2 million of any profit made. They have started down the line to restoring Hinchingbrooke’s finances by making significant savings – through private sector management practices and better procurement.

Ali Parsa points out that on paper supplies alone they have saved £1.6 million. Cleaners have been shifted to clinical areas, rather than offices and residential areas, saving money whilst simultaneously improving hygiene where it matters.

This has all been led by making sure that doctors and nurses are in charge of their services- and using Circle’s private sector expertise to equip them with management skills. Even in accident and emergency – an area where private providers have not historically excelled- Circle have managed to lift Hinchingbrooke’s performance to rank with the best in the country.

Hinchingbrooke’s A&E department is now rated the best in the Midlands and East of England.

Above all, Circle’s greatest strength has been to involve professionals not only in clinical decision making, but in every aspect of health care. Their John Lewis-style partnership model- where doctors, nurses and other staff own 50 per cent of the company- has proved vital for delivering change. As Chief Executive Ali Parsa points out, “Without this model of ownership we couldn’t do what we are doing.”

The lesson for the rest of the NHS is simple. The more control that clinical staff have over the services that they provide the better- particularly in an ownership model that gives them real incentives to do well.

The example of Circle’s success should certainly be encouraging for social enterprises that wish to take over the running of NHS services. Hinchingbrooke also shows what a relentless focus on cutting waste and increasing efficiency can do- even the most financially profligate of trusts can be redeemed with new expert management.

It would perhaps be appropriate to conclude with something that Polly Toynbee wrote back in 2009- the doyenne of NHS scaremongering who should today feel that at least one of her articles has been vindicated. It was after all, Toynbee who said that, “There is no doubt that putting some services out to tender has vastly improved certain standards over the years, broken the power of vested interests and brought in competition that has sharpened up results …

So the answer is flexibility and practicality; see what works best and keep ideology at bay as far as possible.” Amen to that.

Chris Skidmore MP is a Member of the Health Select Committee

From:  http://www.telegraph.co.uk/Hinchingbrooke-shows-what-private-companies-can-do-for-the-NHS

Hospital PFI project went ahead despite warnings

A hospital now losing £44 million a year was allowed to go ahead with a private finance deal to build new premises despite the Government being warned that the project was unsustainable.Hospital PFI project went ahead despite warningsA report, commissioned by the hospital regulator, Monitor, reveals that strong concerns were raised that Peterborough Hospital would not have the money for the new buildings.

Despite the warning – to both the Treasury and the Department of Health – the go-ahead was given for the project, which is now costing the hospital trust £22 million a year to service.

Last year, Monitor found Peterborough to be in “significant breach” of the terms of its authorisation and warned that work on a turnaround plan for the hospital had “not progressed at the necessary pace”. In February, the Government was forced to establish a £1.5 billion bailout fund to help pay the debts created by prohibitively expensive PFI schemes, of which Peterborough was one.

Peterborough is judged at high risk of financial failure by Monitor and is likely to have to cut or reconfigure the services it provides and make staff redundant to balance its books.

In the report, from the accountants KPMG, into what went wrong at Peterborough, auditors conclude that while Monitor was aware of the risks of the project it was powerless to stop the Government from giving it approval.

It is embarrassing for Labour because, at the time of the approval, Andy Burnham was a Minister of State in the Department of Health. He is now shadow Health Secretary.

The report reproduces a letter sent by the then head of Monitor, Bill Boyes, to the hospital trust in 2007 and copied to officials in both the Treasury and the Department of Health, warning of the dangers of the project.

But because Monitor had no power to intervene, it went ahead and it was only in 2010, after the hospital had been built, that the true financial picture emerged.

It has now emerged that up to 30 NHS trusts could be forced to merge, devolve services into the community and make jobs cuts as part of a radical restructuring of hospital care – partly as a result of the cost of PFI.

The Department of Health said it considered 21 hospitals to be “clinically and financially unsustainable”.

Commenting on the report, a Department of Health source said: “This was a disastrous Labour PFI blunder. Labour was warned repeatedly by their own regulator that this PFI deal could bankrupt Peterborough Hospital but they pressed on regardless.”

A spokesman for Mr Burnham said he would not comment until he had seen the full published report.

From: http://www.independent.co.uk/hospital-pfi-project-went-ahead-despite-warnings

NHS is paying for Labour’s dodgy deals

The NHS faces huge costs because of flaws in Private Finance Initiative (PFI) contracts agreed by the previous administration.NHS is paying for Labour’s dodgy dealsYesterday afternoon, the Queen opened the South West Acute Hospital in Enniskillen. She will doubtless have been impressed: the facility, the first to be built in Northern Ireland for more than a decade, is a gleaming shrine to 21st century healthcare.

What may not have been mentioned, however, was that the £276 million hospital was constructed not with public funds, but by a consortium under the Private Finance Initiative – and that the deal to build it included a 30 year “facilities management” contract for one of the firms involved.

The Enniskillen deal may be a shining example of value for money.

But many PFI contracts are not.

Ministers are on the verge of taking over the South London Healthcare Trust, after it proved unable to cope with a bill of more than £60 million a year in interest alone.

One of the trust’s three hospitals, the Princess Royal in Bromley, took £118 million to build, yet will cost roughly £1.2 billion. All told, Labour signed 103 PFI deals for the NHS, at a value of £11.4 billion and an eventual price of more than £65 billion.

The diversion of that money away from patient care will put inexorable pressure on budgets, to the point where some hospitals will crack under the strain.

PFI, in short, is not merely about £22 light bulbs and £875 Christmas trees – it is about budgetary incompetence on a monumental scale.

And it comes as little surprise that it can be traced back to Gordon Brown, who turbo-charged the Tories’ fledgling public-private partnerships in order to buy schools, hospitals and more on the never never.

This allowed him first to evade spending restrictions, and later to splurge on public-sector salaries; in the mean time, the credit card bills got higher and higher.

Many PFI deals delivered what was promised – but where things have gone wrong, as in Bromley, the contracts were often drawn up so poorly that there is little the Coalition can do. Ministers have renegotiated some deals to claw back costs, and should make every effort, and twist every arm, to do more.

They should also remind voters of the ignominious parts played in this debacle by Ed Miliband, Andy Burnham and Ed Balls.

But, above all, they need urgently to produce a way of funding infrastructure that draws on the private sector’s strengths rather than exploiting the public sector’s weaknesses.

Jesse Norman, the Tory MP who has led the way in exposing PFI’s flaws, points out that the state must spend more than £200 billion on new infrastructure over the coming decade, and cannot do so without private help.

The Treasury is beavering away on a new model of funding. If it repeats the errors made by Labour, the cost to the nation will be heavy indeed.

From: http://www.telegraph.co.uk/The-NHS-is-paying-for-Labours-dodgy-deals