Don’t Get Sick!

The Private Finance Initiative is forcing doctors to work dangerously long hours

By George Monbiot. Published in the Guardian 27th May 1999.

Going without sleep for 24 hours, according to a paper published in Nature magazine, is roughly equivalent to drinking four pints of beer. Your responses are dulled, your intellect impaired, your sense of responsibility reduced. As a result, the hours worked by anyone whose lack of vigilance could be dangerous are strictly regulated: lorry drivers, for example, can be sacked immediately for spending too long at the wheel. There is just one exception to this eminently sensible rule. The only people encouraged to work around the clock are those charged with saving human lives.

This week, Britain’s junior doctors believed, the murderous hours they work were to have been brought under control. They had hoped that the European Working Time Directive, which insists that most workers clock off after a 48-hour week, would be swiftly extended to their profession. They reckoned without the tenacity of the British Government. It lobbied and cajoled the European Commission to endanger the lives of British patients for another 13 years. The first four will be the most hazardous, for no new limits at all will be imposed.

As a result, some hospital doctors will continue to work for up to 90 hours a week. They will remain so stressed, so shift-drunk that they will carry on making dreadful mistakes. The junior doctor who killed a baby last month by injecting her with 100 times the recommended dose of morphine is surely as much to be pitied as condemned. The Government argues that the long transition period is required to ensure that there are no staff shortages in Britain’s hospitals. This is true, as far as it goes. But it has told us only the beginning of the story.

Almost all the new hospitals being commissioned in Britain today are funded by means of the Private Finance Initiative: private companies build them, then rent them to the National Health Service. They also take care of the catering, cleaning and portering. By mobilising private capital, the government can open more hospitals than it could otherwise afford, and reduce the public sector borrowing requirement. By cutting the costs of peripheral services, it can plough more money into caring for patients.

That’s the theory, at any rate. In truth, the Private Finance Initiative is a false economy, designed, principally, to appease a corporate lobby desperate to exploit that part of the nation’s wealth still controlled by the state. Far from bringing private money into the health service, it will siphon health service money into the private sector.

Companies investing in the PFI require an annual return of around 12 or 14 per cent. This is supposed to come from two sources: the annual “surplus” the NHS pays to Treasury, and the contracts for non-clinical services. But the surplus amounts to just six per cent of NHS revenue, while the cleaning, catering and portering contracts appear to be able to generate only 3-4 per cent. The rest of the money has to come from the resources allocated to treating patients. The first ten privately financed hospitals to be completed, the British Medical Association calculates, will need an NHS subsidy of £220 million.

This means that both beds and services will have to be cut. Reducing bed numbers alone is achievable: better treatments and new technologies allow patients to be sent home earlier. But it is widely recognised that bed numbers can fall only if doctor numbers rise: a higher turnover of patients imposes a higher clinical and administrative burden on staff. But the NHS will not be able to afford the private companies’ fees unless it sheds staff as well as beds.

The Department of Health’s management consultants, Newchurch, calculate that for every £200 million spent under the Department’s PFI programme, 1000 clinical jobs will be lost. This estimate seems to lie broadly in line with other projections: a report for the Coventry and Warwickshire Health Authorities, for example, suggests that the £174 million Walsgrave Hospital project will result in the loss of 560 staff. The £180 million Edinburgh Royal Infirmary scheme will require the release of almost 900 doctors and nurses.

So how will patients be treated? There is no slack in the hospital system: Britain, according to the accountancy expert Dr Jean Shaoul, has the cheapest public hospitals in the industrial world. GPs’ surgeries and social services can’t absorb many of the extra patients, as they are already desperately overstretched. The Department of Health has no choice but to continue to overwork its staff.

Junior doctors are just the first of the PFI’s many sacrificial victims. The Private Finance Initiative will, eventually, strangle universal health provision, but not before some of the brightest young people in Britain have burnt themselves out trying to keep it alive.