Wednesday, 30 August 2017

Cash ‘leaking’ from the NHS through cost of PFI

A report from the Centre for Health and Public Interest (CHPI) published today highlights the huge cost of Private Finance Initiative (PFI) schemes to the NHS.

PFI is a government backed scheme under which private companies provide money to build new hospitals paid back with interest by the NHS.

The report examined 107 PFI contracts in England and found that the companies involved have generated £831million over the past six years. This money, CHPI say would have been better spent on patient services.

In their report, they call for a cap on PFI costs and for the government to buy out contracts where private companies are making too much profit at the expense of taxpayers.

Speaking to the BBC CHPI chair Colin Leys said the report showed for the first time ‘the huge amount of taxpayer’s money leaking out of the NHS’ through PFI costs.

He added that given the ‘extreme austerity’ faced by NHS services the government needs to act urgently.

Commenting on the CHPI report British Medical Association council chair Dr Chaand Nagpaul said NHS providers and commissioners were ‘being pushed to breaking point’ by the cost of PFI.

He described the scheme as an ‘extortionate drain on the public purse’, and said that private companies were ‘gaining at the expense of tax-payers and patients’, something he said was ‘scandalous’.

Dr Nagpaul backed the call by CHPI for the government to either renegotiate or buy out PFI contracts.

Speaking to the BBC a spokeswoman for the Department of Health said that the NHS was recognised by the independent Commonwealth Fund as being ‘the most efficient healthcare system in the world’, and that PFI costs accounted for just 3% of its annual budget.

Despite the attempts to persuade patients and voters alike differently on the part of the Department of Health this report will have struck a chord with anyone who has used an NHS hospital over the twenty years since PFI was launched.

The buildings may have been transformed from institutional monoliths into the sort of slick architecture that wins prizes, this though, has come at a price.

Private finance has muscled its way into the once sacred turf of the NHS, either in the shape of PFI or retail outlets turning the foyers of hospitals into another place to shop or sip coffee.

There is a real risk this may pave the way for privatization by the back door, if Costa can sell you a coffee while you wait to have your ingrown toenail fixed, why can’t Virgin provide the chiropodist who sorts it out?

That is a question the founders of the NHS would have been shocked to hear asked, because they know that behind it lurks the much more troubling one of how do the people who can’t afford a skinny latte, let alone the cost of falling ill, pay for their healthcare in a system where the hospitals all look like hotels.

Wednesday, 9 August 2017

Breaking Point: Inequality is damaging our mental health.

Mental illness is something many people will experience over the course of their life in one form or another. It is something we are more comfortable talking about now than we were in the past, even so a worrying level of stigma still surrounds the issue.

This is deeply problematic because, as one leading charity has noted recently, the decline in our national mental wellbeing is a potential public health crisis. One that has its most damaging impact on the most vulnerable members of society and can be linked to the ‘austerity’ policies of the past decade.

The shocking reality is that behind the glitz and gleaming glass towers, the regenerated mill towns and the new tech based industries, if you are poor, unemployed or in a low paid job; then your physical and mental health will be worse and you are at risk of dying sooner.

In their ‘Surviving or Thriving’ report published earlier this year the Mental Health Foundation painted a bleak picture of the mental health of the UK in 2017. Out of the people they spoke to as part of their research 65% said they had experienced some type of mental health problem, amongst the respondents who were unemployed or in low paid work that rose to 85%.

The most common problems reported were depression, anxiety and panic attacks, all of which can be linked to the stresses associated with life in the ‘precariat’, as the new class of insecure workers have come to be known.

The report concludes that the mental health of the UK is deteriorating, with the young and members of the lowest socio-economic group suffering most. This is reflected in the number of people accessing mental health services, NHS Digital record this as 1,227,312 for the year to March, with 7843 people requiring treatment on acute wards and 5637 on general wards, 21.2% of the people who accessed mental health services over this period were aged under 19.

Is there a case for attributing this decline in our national mental wellbeing to inequality as the Mental Health Foundation claims? Another charity, The Equality Trust has highlighted some indicators that the gap between the rich and the poor in the UK has grown alarmingly over the past decade.

These include concerns expressed by UNICEF about levels of child poverty, the Social Mobility Commission saying that twenty years of government policy initiatives have failed to ‘level the playing field’ for individuals and communities living in poverty; and research published by Oxford University suggesting the number of people using food banks is set to rise.

Over the past ten years the poorest tenth of the population has seen a huge fall in its collective income to just 1.3% of that for the nation, the richest tenth claims 31% (source: The Poverty Site). This has resulted in a situation where, as Christians Against Poverty put it the poorest and most vulnerable people are forced to walk a ‘financial tightrope’.

Faced with such a situation on a daily basis is it any wonder that it has a detrimental impact on people’s physical and mental health?

Health inequalities, both physical and mental, can be linked, among other factors, to the amount of control an individual’s socio-economic position gives them over their daily lives. Unemployment, poor housing, lack of security for those in low paid work can all aggravate health problems. The poor die younger and when people in that group have been diagnosed with a psychiatric illness, they die even younger still.

Mental health problems amongst people who are out of work can be linked to loss of status and a sense of purpose, along with grinding money worries and the relentless struggle to qualify and retain even the limited support on offer from the DWP. Even when people find a job working, if the job in question is low paid, insecure and repetitive can cause stress levels that are unhealthy.

City life is more stressful than rural living, particularly in disadvantaged communities where there is more vandalism, higher crime rates and more opportunities to make unhealthy lifestyle choices. People living in disadvantaged communities also tend to have weaker social support networks and members often lack the social and cultural capital necessary to seek help effectively.

For people living in such circumstances and experiencing mental health problems along with all the above problems there is the added difficulty of stigma making them into a separate minority existing on the edge of an already marginalized community.
The government defines tackling inequality as:

‘Addressing the causes and consequences of stigma, discrimination, social inequality and exclusion on service users, carers and mental health services’
(cited in Pilgrim, 2008: pp105)

The evidence shown so far demonstrates that despite claims to the contrary the current government, and many of its predecessors, has failed to do so in any meaningful way. There is, sadly, little chance that any government will so long as we as a country remain wedded to the economic and social policies of the past forty years.

There is a need for fresh and radical thinking of a sort the three mainstream political parties simply cannot provide. In this respect, as in so many others, the Green Party has a real alternative to offer.

In their manifesto at this year’s general election they said they would bring mental healthcare in line with physical health, making parity of esteem a reality not just an empty promise. They also pledged to tackle the stigma surrounding mental illness and to tackle the inequality that causes it by reforming the benefits system.

In their wider policy offer they called for the introduction of a four- day working week to help reduce workplace stress and make our economy more productive. They also said they would take steps to look into introducing a universal basic income to close forever the poverty trap and set people free to be more creative.

Theirs is a vison of a fairer Britain that really does work for all its people. A country where wealth and opportunity are shared for the good of all.

As a volunteer and trustee at two mental health charities I fully endorse the Green Party’s plans to tackle inequality and the health problems it creates.

Over the past century Britain has made huge strides in overcoming many of its public health problems, at the same time we have consigned once entrenched prejudices to the cultural dustbin. I believe that with the sort of fresh thinking provide by the Green Party we can do the same for mental illness and the stigma that still too often surrounds it.