I'D like to start by telling you a story. You may already have heard it – it's the one about George Osborne and the Christmas tree. Keen to contribute to the belt-tightening supposedly going on in Whitehall, the Chancellor decided to nip down to B&Q, get a cheap Christmas tree for £40 and decorate it himself (or, more likely, get a passing Lib Dem to do it).
But the company which had been contracted to look after the decorations as part of a private finance initiative (PFI) scheme told Osborne that if he didn't let them provide the fully-decorated tree for 875, as contracted, there would be appalling consequences, not least the health and safety implications of non-yuletide decoration operatives going up ladders to put the fairy on top. That one little story encapsulates the madness that is PFI.
Now imagine a forest of those 875 Christmas trees. It contains 240,000 trees – worth 220m – and I work in that forest. Or, to be more exact, I work in Bexley Wing at St James's Hospital, the wonderful new cancer treatment centre in Leeds. Like most hospitals built by New Labour, it was a PFI-funded development, and it cost 220m.
By the time our children and grandchildren finish paying for it in 30 years, it will have cost anything from 700m to over 1bn, depending who you believe. Across the NHS, it has been estimated that PFI schemes will eventually cost 50bn for buildings worth 11bn. Why such reckless disregard for the taxpayers' money? It was done to keep the capital costs off the balance sheet of 'prudent' Gordon Brown.
It's not just PFI that casts doubt on the wisdom of involving the commercial sector in health care provision. Let's take another local example – a few years ago, it became apparent that the UK was seriously under-provided with facilities for PET/CT scanning – a relatively new imaging technique which is particularly useful for diagnosing and staging cancer, and for monitoring response to treatment.
It isn't essentially any different to other scanning techniques used by myself and my colleagues, but it did require expensive new equipment. To their credit, New Labour recognised the need to increase provision, but insisted that the service must be provided by the commercial sector. The PET/CT scanners would initially be mobile units which would gradually be replaced by fixed-site installations, and the service would be wholly delivered by the private companies, with no local NHS involvement.
The scans could not be reported by me and my colleagues, but must go to non-NHS radiologists at remote sites which, for the Leeds service, was Barcelona!
Inevitably, remote reporting could not be made to work, and the job was taken on by the local radiologists, which is what everyone wanted in the first place. We also ended up doing lot of the administration ourselves, and eventually had one senior member of our staff, sometimes more, spending most of their time trouble-shooting, and trying to ensure that the right patients were booked at the right time. It's difficult to avoid the conclusion that if they had just given us the cash to buy the equipment in the first place, a lot of money could have been saved and a great deal of inconvenience, for staff and patients, avoided.
These examples, and experience gained in a number of other brushes with the commercial providers of health care, demonstrate that the private sector isn't necessarily more efficient or cheaper than public provision. There is a place for the private sector, but pouring money into the pockets of entrepreneurs regardless of the quality of the product is irresponsible.
And now, of course, we have Andrew Lansley's fundamental reorganisation of the NHS. Such a major restructuring has as much chance of working straight out of the box as last year's Christmas tree lights, and it seems almost inconceivable that Lansley is still using the 'competition' word as one justification for his faith in the project.
Competition only works as a driver for quality or price where supply exceeds demand, and that is never going to be the case in health care. But of course, what is really meant by the word in this context is competition in service provision; allowing more private companies into the field, with contracts going to the lowest bidder. This will inevitably lead to the fragmentation of the Health Service, and some may conclude that this fragmentation is the real agenda driving the 'reform'.
So what is my New Year message for the coalition? It's just this – for pity's sake slow down. Everything you propose for the NHS can be achieved by a process of evolution – the PCTs could still be phased out if that's what you want. If you insist on a big bang implementation, the most likely outcome is chaos, which could be a terminal event for the government.
And don't depend on the private sector to take the troublesome NHS off your hands – the most important word in National Health Service, as far as most voters are concerned, is 'national', and you ignore that at your peril.
Bob Bury is a hospital consultant in Leeds who retires this month.