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Column 4th March 2020

Tangle of Trusts and backlog of big bills hamper our NHS

Why are our health services so short of funds?

I think it comes down to two things: firstly the Private Finance Initiative (PFI) which was used from 1997 to fund new schools, hospitals etc. and secondly to restructuring of the NHS when all these Trusts were set up to manage health services on our behalf.

The total bill for NHS PFI hospitals is projected to rise to about £80 billion, way in excess of original build costs of £11.4bn.

The outstanding PFI payments would cover the pay for all the nurses, full-time consultants and GPs for 10 years. There would still be plenty left over to cover the training of the next generation of surgeons and build 80 state-of-the-art hospitals.

In the mid 1990’s public services were in such a diabolical state of neglect that there was no alternative to the private financing of whole swathes of infrastructure.

Many of the PFI deals struck to replace crumbling buildings were linked to the retail price index and included not just the building costs but the ongoing maintenance. This means that even changing a light fitting can be very expensive.

These costs have risen faster than NHS trusts expected, lumbering them with ever-bigger payments at a time when their budgets are being squeezed.

PFI projects in Oxford include the £20m Oxford Children’s Hospital and JR West Wing, the Oxford Cancer Centre, and the Nuffield Orthopaedic Centre.

The Oxford University Hospitals Trust faces an annual bill of about £53 million to fund repayments on these projects.

Then the restructuring of the NHS. When these Trusts were set up the various bits of the NHS became separate businesses with their own administration and management teams. The money going to each of the Trusts also had to be monitored so more Trusts were set up to oversee the operational trusts.

In Oxfordshire, we currently have the Oxfordshire Clinical Commissioning Group (OCCG), Oxford University Hospitals Trust (OUH), Oxford Health NHS Foundation Trust (OHT) and 70 separate GP practices. Each organisation has administrative staff in addition to clinical staff.

OCCG doesn’t deal with patients but cost £14.7 million last year.

OUH runs four hospitals (John Radcliffe, Churchill, Nuffield Orthopaedic Centre and Horton General) and has 11,836 staff, including 3,779 nurses and midwives, 1,829 doctors and 1,622 healthcare support workers.

So what do the other 4,606 staff do?


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