Extraordinary NHS mismanagement of their funding

It's only the taxpayer's money so who cares?

NHS hospitals have paid more than 120 pounds ($240) an hour for agency workers to fill staffing gaps during the past year, according to figures obtained under the Freedom of Information Act. The payments included 96.75 an hour for a GP in Wolverhampton, 100 an hour for a human resources manager in Blackburn, and 121.59 an hour paid for a nurse in a Berkshire hospital.

The figures, which were obtained by the Conservative Party, form part of a bill for NHS agency staff that totalled 1.18 billion in 2005-06, the last year for which the Department of Health has released figures. The total amount was down from the 1.45 billion that was recorded in 2003-04, but more than double the 540 million spent in 1997. Average hourly pay rates for NHS employees are 15.66 for a nurse, 24.14 for a junior doctor and 60.31 for a consultant, based on the 37.5-hour standard working week, the Tories said.

Andrew Lansley, the Shadow Health Secretary, said: "Labour's chaotic short-term planning has let down NHS staff. Some stability for them is the least we would have expected from the billions that the Government has poured into the NHS." He added that it was incredible that agencies could be paid such high hourly rates for staff at a time when jobs were being cut.

The Conservatives asked NHS trusts to reveal the top hourly rates that each had paid for agency staff during the previous 12 months. The highest figures also included 121.10 an hour for a nurse at Chesterfield and Royal Hospital NHS Trust and 111.96 for a nurse at Salisbury NHS Foundation Trust. The highest hourly rate for a non-clinical worker was 119 for a turnaround director at Coventry Teaching Primary Care Trust, followed by 110 for financial staff at Heatherwood and Wrexham Park Hospitals NHS Trust and 106.66 for a director of healthcare and procurement at Havering PCT.

Some trusts appeared to have kept agency costs more strictly under control. Bath and North East Somerset PCT said that the most it paid was 31.15 per hour for a nurse, while the South Western Ambulance Service NHS Trust's most expensive agency worker was a temporary deputy finance director at 33.33 an hour.

Temporary staff are employed across the NHS to meet fluctuations in activity levels and to cover vacancies and short-term absences. Trusts obtain temporary workers from their own nursing bank, from private agencies or from the NHS-run temporary staffing service, NHS Professionals. A 2007 report by the House of Commons Public Accounts Committee said: "Properly managed, temporary nurses play an important role in helping hospitals achieve flexibility. "Excessive use can be costly, particularly when trusts are heavily reliant on agency nurses. High use of temporary nurses can also have a negative impact on patient care and satisfaction."

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More on the RomneyCare failure

As he campaigns across the country this week in anticipation of the Super Tuesday primaries, Mitt Romney probably won't say much about the storied health-care plan he signed into law as governor of Massachusetts. For one thing, it is hard to portray yourself as the ideological heir to Ronald Reagan when your health-care plan is virtually indistinguishable from the one proposed by Hillary Clinton. But another reason Romney may not want to talk about his plan is that it has been a dismal failure.

The Massachusetts plan was supposed to achieve universal health coverage while controlling costs. As Romney wrote in The Wall Street Journal, "Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced." Or not.

The Massachusetts plan might not have achieved universal coverage, but it has cost taxpayers a great deal of money. Before RomneyCare was enacted, the number of uninsured Massachusetts residents was estimated at 618,000. Under the new program, about 300,000 previously uninsured residents have signed up for insurance. But of these, 169,000 are receiving subsidized coverage, proving once again that people are all too happy to accept something someone else is paying for. Another 70,000 people have also been enrolled in Medicaid, meaning a total of 239,000 people are receiving taxpayer-funded health insurance. Of those who have signed up for insurance since the plan was implemented, slightly more than half have received totally "free" coverage. Only 60,000 unsubsidized residents have bought insurance in order to comply with the mandate.

And though the subsidies have increased the number of Massachusetts citizens with insurance, as many as 300,000 Massachusetts residents have failed to buy the required insurance. Thus, half of those who were uninsured before the plan was implemented remain so.

The Massachusetts plan might not have achieved universal coverage, but it has cost taxpayers a great deal of money. It was originally projected to cost $1.8 billion in 2008, but it is now expected to exceed those estimates by $150 million to $400 million. Over the next decade, projections suggest that RomneyCare will cost $2-$4 billion more than was budgeted. Given that Massachusetts is already facing a projected budget deficit this year, the pressure to raise taxes, cut reimbursements to health-care providers, or cap insurance premiums will likely be intense.

The cost of the Massachusetts plan is also likely to continue rising, because it has failed to hold down the cost of health care. When Gov. Romney signed the bill, he claimed "a key objective is to lower the cost of health insurance for all our citizens and allow our citizens to buy the insurance plan that fits their needs." In actuality, insurance premiums in the state are expected to rise 10-12 percent this year - twice the national average.

A major cause is that the new bureaucracy the legislation created - the "Connector" - is not allowing Massachusetts citizens to buy insurance that "fits their needs." For example, the Connector's governing board decrees that by January 2009, no one will be allowed to have insurance with a deductible higher than $2,000 or total out-of-pocket costs of more than $5,000.

In addition, every policy will be required to provide prescription drug coverage, a move that could add 5-15 percent to the cost of insurance plans. A proposal to require dental coverage failed narrowly, but the dentists - and several other provider groups - have not given up the effort to force its inclusion. This comes on top of the 40 mandated benefits the state had previously required, ranging from in vitro fertilization to chiropractic services.

Romney now says that he cannot be held responsible for the actions of the Connector board, because it's "an independent body separate from the governor's office." But many critics of the Massachusetts plan warned him precisely against the dangers of giving regulatory authority to a bureaucracy that would last long beyond his administration.

Executives often blame others for the failures of their own policies, but that's not a tendency one looks for in a candidate. Romney claims he is a "true conservative" with the business expertise to "get things done." Judging by his experience with health-care reform, far from it.

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