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Troubled waters

Are MPs wearing rose-coloured spectacles on the NHS Titanic?

Illustration of passengers of the 'NHS Titanic' sitting in deck chairs being waited on My local MP could see nothing wrong with claiming for the expense of a mattress for his child's cot, against his second home allowance; nothing at all.

That was, at least, until the Daily Telegraph published a list of his expenses, including a £500 night in a local five star hotel.

My local MP has two homes – neither of them in the constituency. Why would he want to live amongst the peasants? He doesn't. Well he didn't until the Daily Telegraph drew attention to it.

There is no doubt about it, the Daily Telegraph should run the country. More recently, the Daily Telegraph turned its attention to how the public services are to fare after 2011.

The politicians, exhausted by climbing to the apogee of apology, have been reverting to type, that is, dissembling, obfuscating and generally taking the public for mugs. They have been pretending that, after the current round of public sector funding commitments runs out in 2011, nothing will change and we will go on throwing money down the big, black hole called health, schools and overseas aid.

Anyone with a household budget of two shillings will realise this is plain daft. The economy is down the toilet, tax-take is at an all-time low and we are up to our arm-pits in debt. Something's got to give.

Tory health spokesman, Andrew Lansley, blinked first and said that everything, apart from health, could expect a cut. Andrew Lansley promised that a future Conservative government would give the NHS "real-terms" spending increases, even if that meant 10 per cent cuts for other parts of the public sector. Labour's Ed Balls said that was all... er, balls. Tory Shadow Chancellor, George Osborne, said it took the biscuit, and the real Chancellor said everyone was wrong before popping next door to borrow an answer. The minor politicians carried on with a punch-up that only they thought was important, cogent or rational.

The NHS is already under pressure to contain expenditure and cut costs. The Institute for Fiscal Studies' (IFS) annual post-budget briefing said they reckon that once expenditure the government can't cut is factored into the Chancellor's 0.7 per cent "real-terms" growth figure for 2011–12 onwards, departments such as health, education and the police will be left with real-terms cuts of 2.3 per cent a year.

IFS' very bright research fellow, Gemma Tetlow, breaks it down as such: debt interest payments will need to increase by 8.4 per cent a year. That alone cuts the 0.7 per cent increase down to a 0.6 per cent decrease for the rest of public spending. It gets worse. Social security spending on things like unemployment benefit will rise during the recession by around 1.7 per cent. That takes the rest down to a 1.6 per cent real-terms cut a year.

Add to that other non-department spending which seems pretty immoveable, and that the IFS reckons will continue to grow by around 1.9 per cent, and it leaves the rest of public spending with 2.3 per cent real-terms cuts per year.

Public spending hasn't been so tight since the end of the 1970s and that, I can tell you, was no time to try and run health services.

However you look at it, through rose-coloured glasses or blue-tinted specs, post-2011 will be a tough time.

Last week the NHS Confederation, widely regarded as the Department of Health in drag, held its annual conference.

The NHS boss, the portly "Mr Health" himself, David Nicholson, expounded, "The NHS must plan for real-terms cuts, despite protestations from the government and the Conservative opposition that they would continue to give it real-terms increases."

You will have noticed that Mr Nicholson was absent from Her Majesty's birthday honours list.

Mr N ploughed on, "I'm a manager, not a politician." Yes, neither are you a diplomat. There was a hint of 'end of term' about his performance. Strangely de-mob-happy?

Within days of his speech, his departmental side-kick, Mark Britnell, constructor of that modern myth and fad, world-class commissioning, had thrown in the towel and resigned. He left to go and work with consultants who had been helping to construct the myth. Where's the Daily Telegraph when you need it?

Nicholson told his audience, "Sometimes there are downside cases and we need to make sure we cover these downside cases. It's great politicians have said they will increase [funding] in real terms. I believe they absolutely want to provide more resources for the NHS. But if they give us extra money, the taxpayer will expect more for it. So, even if they give us more money, we will need to do even more with it."

It seems to have escaped Mr N that the taxpayer has given the NHS a three-fold increase in funding since 1997. What have we got? Reductions in waiting times that do not really bear international comparisons and doctors paid a shedload of money. Now there's value!

Warming to his theme Nicholson said, "If we don't think about it again until Christmas and we just carry on we will get to the end of 2010–11 and suddenly the money will dry up and we will have to rush around trying to solve the problem."

Nicholson spelled out the answer; the NHS should first address issues like variation in performance, poor value procurement and back offices and the "huge numbers" of patients who were treated in hospital when they didn't need to be.

Very good. Where has he been for the last ten years? Indeed, the NHS should have come to grips with all that in 1989 – the year of the Thatcher reforms.

Helpful as ever, Nicholson added, "Some of those proposals may contradict the new NHS constitution."

Well, as the new Secretary of State, Andy Burnham, was the originator of the NHS constitution, that'll go down well.

What's the answer? We need a new deckchair attendant on the good ship NHS Titanic. Who better than the editor of the Daily Telegraph?

Alternatively, keep the politicians away from the NHS and let an independent board do the job.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster.
To comment on this article, email pm@pmlive.com

17th July 2009

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