Cut the...
Just on my way to hear David Cameron talk about his favourite three letters - NHS. The Tories are stepping up their campaign against Brown's "cuts" in the health service. Labour is responding by alleging that the Tory policy for the NHS is "cuts, cuts, cuts", since Cameron is pledged to "cut" £17 billion from public services.
Good grief. Can we just get a few facts straight before this rhetoric of slash and burn gets out of control?
This government is on course to have trebled NHS spending since coming to power. The deficit in the NHS is small - the equivalent of someone with an income of £20,000 overspending by £160 in the course of a year. The "cuts" the Tories talk of are - usually - posts being cut and not staff. They stem from the failure of certain hospitals to control their spending and the decision of central government to try to resolve this in a single year. In other words this is an issue of management not total resources. Clearly, if it's your post going or it's happening in your hospital it will feel like a cut but these are not "cuts" as we have known them.
The last Tory government also increased health spending in real terms - albeit though at a significantly lower rate. The Conservative health spokesman, Andrew Lansley, now says he regrets the fact that the rate of increase slowed in the last few years of the Major government and believes that Labour were right to increase NHS spending. The Tories have committed themselves to real terms increases in NHS resources and are likely to match whatever Gordon Brown announces in this summer's spending review. By promising to "share the proceeeds of growth between public spending and tax cuts" they will need to convince people that they can grow the economy faster than Labour, or find savings in new places. In any event, there's no evidence they're committed to NHS cuts.
Why am I challenging both main parties' propaganda? Because it does nothing to aid public understanding. All politicians know that there are forces at work which have nothing to do with cash spent but which will dramatically alter our hospital provision - moves towards specialisation, reductions in the time patients need to stay in hospital, changes in approach to Accident and Emergency.
Is it too much to ask that this should be discussed above and beyond the talk of "cuts"? Probably, but here's hoping...
I'm 
Comments
There's a curious dichotomy in what David Cameron is declaring as his Party's tax and spend policy. He's already pledged that his government would share the fruits of GDP growth 50:50 between public and private spending. That implies a rapidly growing tax collection. Now he's promising cuts in expenditure. Why the difference?
What's wrong with cuts? Surely if public spending is out of control as it seems and taxes are crippling, as they are for some of us who recieve no benefits whatsoever, cuts are favoured by the tax paying (also now seemingly a minority). Or is it a non vote winner since the public sector workers seem to now outnumber the private sector and in order to give value for money the public sector would have to be reduced to 1997 levels or even worse privatised? I'm all for cuts (rather than even more tax rises by stealth or otherwise) since record investment in the public sector has resulted in services actually seemingly to get worse from personal experience. I'd rather pay less tax at any cost than see the waste and inefficiency that this nanny state has produced. Politics is all about public perception and at the minute I percive that I was better under the Tory government of 1997 than now and at that time I never thought I would ever say that!
Careful Nick. You might cause a revolution in politics where the real issues at hand are debated in a mature manner.
That'll never do.
:-)
NeilW
Labour's been throwing false allegations at its opponents for years, and you've never had a problem with that. In fact, the 91Èȱ¬'s done it all it could get away with to support them. What's changed now?
Political pundits such as you, Nick, seem to be the only ones obsessed with "cuts".
By the way, talking of the changes Cameron is making, and bearing in mind the Tories won England last time, is he changing merely to appeal to Welsh and Scots?
good article.
Nick, you've swallowed the Government's spin hook line and sinker. These cuts are not because some trusts are incompetently run, they are because Labour's funding formula ensures more money per patient goes to traditional Labour areas, and less money per patient goes to traditional Tory areas.
When you talk about the NHS, do you mean:
a. The English Health Service (EHS)
b. The Scottish Health Service (SHS)
c. The Welsh Health service (WHS)
d. The Northern Irish Health service (NIHS)
Thanks for clearing that up.
The "Big endian's" and the "Little endians" return! I suppose Labour are the "Big endians" with their "Spend anyhow until the money runs out and then cut" approach versus the Tories " Cut until the screams get to loud to bear" approach. Trouble is neiither of them seem to be clear whether they are trying to make scrambled eggs, an omlette or a soufle and certainly no idea of the number of portions needed nor what the final bill should be. Whilst the proverbial parson would perhaps still claim that each is "quite good in parts" to me they both seen totally addled with more of it on their faces than is left to go round.
This theme could run and run..... Oh shut up John this is getting much too eggcentric.
good article, very incisive..... if onyl if was actually reported like this in the print media
Nick,
Dream on!
Quite right Nick.
Here in Stoke-on-Trent we had, like a few other areas, managers who spent more than they had to spend.
This has created upset and guess what? Politicians get the blame.
Very unfair, but very true and par for the course.
The more accurate truth is that we are dispensing with our two old hospitals and building a brand new one in their place.
A new hospital for a new Century.
The problem I have is with the notion that the Tories will never cut this approach to a better health system. The Tories will, if we allow them, travel along the path of more independant and private health insurance. This would inevitably drain resources for a viable and examplary health service via the public sector.
The Tories have within their ability to offer the opt out of NHS contributions, which could result in a two tier system.
I'm not fooled by a Tory wolf in socialist clothing, thanks very much.
Gary
Great topic, Nick. You’re right, the simple and shrill screaming of soundbite politics isn’t very informative. I like the way you’ve taken a step back and raised the issue of fitness for purpose. As problems and solutions change, resources can move up and down. The simplistic monopoly that finance has on politics doesn’t address this. On its own, like numbers of beds, pills, or doctors, the number means absolutely nothing.
I don’t know what you plan to write, or how effective this approach will be, but politicians and public can be trapped in megaphone politics and need a little help. Approaches like the one you’ve just taken can help turn the volume down and give all stakeholders an opportunity to offer more considered views. Personally, I’m fed up having the tail wag the dog, and if this helps a better quality dynamic, you'll have my thanks.
The reason the Conservatives have been forced into the misleading rhetoric of "Cuts!" is that the Labour Party has been permitted, for the past twenty years, to lie and lie and lie, alleging "Tory Cuts!" when no such cuts existed. The Conservatives have tried for two decades to explain, but without success. So now we, too, will yell and scream nonsense - at least neutralising Labour's lies, even if not adding much to public enlightenment.
Quote:
"Why am I challenging both main parties' propaganda? Because it does nothing to aid public understanding."
But the propaganda is working Nick since in this article you only talk about Labour and Conservative. Once again the views of other parties are not considered and we are presented with bi-polar British politics. Propaganda by its very nature should do everything BUT aid public understanding!
Jeff
Do the main parties actually have a health policy more in depth than "throw money at it", or do they think it's too complex for the electorate?
The following 3 things seem to be missed from everyone's outlined agenda.
1:) While funding has increased it is nowhere near to covering the deficit that has built up over time between the NHS and the leading health services we are being compared to. Yet nationally we are expected to ,and do for the most part do, meet or exceed equivalency in service provided.
2:) Staff morale is very low, while many trusts aren't in deficit this year, recruitment freeze, especially of new graduates, occurs anyway for next years count ( 6 months away at the end of this month). This is not helped by the fact that post removal while perhaps not removing people from jobs( although I know people who have lost their job with the post). Does in fact lead to a lack of additional staff presence, which increases pressure on staff and wards that are dangerously close to the limit as it is.
3:) A recent survey found "only" 2% of new british mediccal graduates were unemployed and that this was "not unreasonable". What it fails to mention is that this survey was conducted just after a recruitment drive by countries that will happily accept and TRAIN newly qualified british health professionals.
In brief we have more money , but not as much as we need to match the standards set down.
We have better paid staff, under considerably more pressure to meet standards not all of which are agreeable or even explicable to them.
We have more trainees, but they are faced with a choice between a system all to frequently unwilling to train them or give credit for non-training post work, and sunnier climes that will.
Remember this was our "best year ever" Is it any wonder strikes have started?
Nick, I agree. The current debate does little to help decide who has the best policy.
As a casual political observer the main problem I find is trying to understand who is telling the truth. Come election time you are faced with parties shouting different things but causing confusion to the electorate over what the party would actually do in power.
This I think does little to improve the integrity of politics. Then politicians are confused why not many people come out to vote!
Actually Nick you are completely factually wrong about the current Labour NHS cuts. My local hospital, Whipps Cross, has closed the terminal cancer care unit, laying off all of the staff, is not employing any of the newly qualified nurses it has just trained, instead asking them to work for nothing as "volunteers",has made redundant the Health Visitors and most of the community midwives. Now our health trust is talking about closing all acute facilities at the Hospital leaving it as only an accident and emergency centre, with patients then having to travel a very long way to Oldchurch Hospital in Romford, a journey nearly impossible by public transport.
Please don't fall for the Labour spin on this one Nick, your facts are just plain wrong; there are real cuts occuring to front line medical services leading to real redundancies and real losses of services.
If the Tories didn't 'cut' when in power how come the NHS was in such a state of delapidation in 1997. My local hospital, A&E dept. etc. has seen massive investment in the last 7 years and its made a massive difference. If the Tories didn't cut, they were certainly guilty of under-funding (I suppose its hard to cut when the funding is already insufficient).
I just want to comment on this excellent post.
I really wish the 91Èȱ¬ would concentrate more on analysing the spin and propaganda of the main parties.
"To inform, educate and entertain." You've just succeeded in all three as far as I am concerned.
Please please please more of this type of analysis.
Under the proposals now about to be forced through some of the, excellent, services provided by out local hospital will not available be in the future.
If that is not a "cut" I don't know what is.
"* At 05:20 PM on 09 Oct 2006,
* Gary Elsby stoke-on-Trent
The problem I have is with the notion that the Tories will never cut this approach to a better health system. The Tories will, if we allow them, travel along the path of more independant and private health insurance....I'm not fooled by a Tory wolf in socialist clothing, thanks very much.
Gary"
Gary - the air ambulances are run by charities, so are the Hospices there isn't an NHS dentist in sight, we pay for our prescriptions and there are hospitals closing everywhere.
At what point will you finally concede that Labour has wrecked the NHS?
Nick, please do all you can to write and promote more political journalism like this piece -- the issues rather than the froth. The parties and the media are in a vicious circle of irrelevant sound-bytes; the parties overstate and spin their cases, then the media reports the phoney confrontations because no one media outlet can afford to tell the boring nitty-gritty situation while its media rivals repeat the sexier confrontational pap. In this piece you step outside of that tedious dynamic and tell us the facts; more please.
What is a cut? A particular activity costs £10 million in salaries and resource input, and a review identifies a way of carrying out exactly the same activity at a cost of £7 million. Is following the less expensive option a cut?
What is the NHS for? To provide an efficient cost-conscious national healthcare service? Or to provide employment for 1.2 million people and a largely unchallenged income stream for the others who supply it with services, equipment and materials? The two concepts are incompatible.
What will it take for people to realise that the country is just like a family? There is an absolute limit on how much is available to be spent, and resource committed to inefficiency, irrelevence and low value-added is ALWAYS capable of more appropriate use elsewhere.
I'm not completely convinced by the idea that jobs aren't being cut, it's just posts that are going.
My local hospital (Hinchingbrooke, Huntingdon) has already cut 200 jobs/posts/staff and is believed to be about to close its maternity and A&E departments, with a £22 million treatment centre that has been open less than 12 months to be sold to the private sector.
Nearest A&E/maternity will then be 25 miles away and obviously further for people on the far side of Hinchingbrooke. It's hard to see where the trebling of money has gone.
Great post - I'd like to see more topics so clearly explained without the party politics.
Very good points in article.
I like the take home point that the defecits in many PCTs, and whole NHS although large in cash terms are only a small percentage of budgets. often the pain being caused by re-balancing books in one year seem out of proportion to the gains. It takes a long time to build up a team, but it can be destroyed quickly and only save a small amount.
There is a place for managing the public's expectations of the NHS. It would be nice if any of the politicains came out and pointed out the seemingly obvious fact that the NHS can not now, and never could, or never will, be able to provide the ultimate care to every patient. It is concerned with the health of the nation en-mass and if there is a particularly rare condition that for example kills 5 people per year, it is not really rational to devote much national resources to that condition, when we kill around 10people per day on the roads, and even more, about 5,000 per year die as a result of medical intervention!
If politicians, and commentators spent more time explaining the realities of health care, and less on trying to score cheap points of each other, the county would be better cared for. The party that has the guts to tell people what is right, not just what they want to hear will go far!
I agree with many of those commenting that this style of reporting is excellent. But it's worth remembering that the soundbite (or headline) is an artifice of the media, not the politicians. So, a challenge: What are YOU (and your colleagues) going to do to ensure that reports like this replace soundbites on mainstream radio and TV? If politicians don't have to respond at headline level, we may get better level of debate from them, particularly on issues.
Also to be wished for is a time when politicians - and commentators - distinguish between input (aka spending) and output, or even better, outcomes. A 100% or 600% increase in spending on the NHS is meaningless if it doesn't translate into better care, lower wait times, faster response and all the other measures that the consumer is actually interested in. As a taxpayer, I may be happy that more of my taxes go to the NHS, but I'm extremely unhappy if it gets us nowhere in terms of real improvements. Likewise with cuts, I may not want to see the NHS diminished, but where's the evidence it is making the most of what it gets now?
Well done, you dodged the press trap!
The little communications trick I'm referring to is where you fill your speech full of little hints that have "the press" sifting like obsessives, and so avoid any actual analysis of their policies filtering through to the public. I have to fight so hard to get to the content of peoples speeches I have no time left to decide whether I agree with them or not! If there is one thing I would ask you to do, is to quiz politicians on the actual economics of their policies, and how they are supposed to work, and then communicate it in a jargon-free way. Maybe you could get someone to do a diagram. :)
My three words: brilliant, brilliant and brilliant.
This was a brilliant post - fair, accurate and informative. It is what news really should be. I agree fully with the people who have praised you above.
Well done Nick, thank you and please keep churning out reports like this.
Well done, Nick Robinson. I notice that most of your gainsayers in this string of comments have some political axe to grind.
The rest of us can applaud you for cutting to the chase.
Nick
Interesting article but you have swallowed too much spin.
Labour has raised NHS spending significantly.
It has spent money on entirely the wrong things. Service significantly mismanaged from top down.
It has spent money on projects that damage existing hopsitals and give no improvement in return. It has constantly been ruthless about the game of "central credit, local blame."
In Private Eye 1169 13/10/06 p12 the cost of management consutants in NHS is £325million per year, cost of medical consultants £340 million per year.
Labour has made all processes harder and more expensive to perform.
Front line staff more harassed than ever. Bureaucrats running around to ever more meetings to ever less effect.
Cuts or no cuts, money money money. Lets get things in perspective, one of th emajor issues in th eNHS has to be staff. Both my wife's parents have recently spent some time in local hospitals and whilst the standard of care from some nurses was excellent generally the standard was poor as agency nurses took shifts merely to plug holes in staff levels at awkward times. Many of these staff were foreign who did not have the same standards of nursing care as some senior career nurses, simply treating it as a job with a patient be a commodity.
I'm sure if more effort was put into quality of nursing at all levels and getting good full time staff in the NHS would improve and the political squabble of the service and how much money is being spent will drift into the back ground.
Rob hits the nail on the head in Message 30. The prevailing mindset in this country is that the value of outcome is directly commensurate to the cost of input, so that committing more and more resource to, say, the NHS guarantees a rise in the quality of its performance. What is conveniently ignored is that the validity of this assumption depends entirely on the suppliers of service being governed by an ethic of reciprocity and not self-interest. This is quite clearly not the case.
Anonymous wants to know when I'll concede that the NHS is 'wrecked'
When the waiting lists go up, the staff have a drop in pay, my NI contributions go down and we pay at the point of delivery.
And you reckon you're going to win the next election!
Deal or no deal, for mr. Cameron?
It's a no deal from where I'm sitting, mr. Brown
Gary
Tax cuts not yet says cameron,wait till we are in government, oh and by the way i am Dave, remember me the guy how write the last conservative manifesto with 20Bn pounds worth of cuts,oh yes when the time comes there wont be a service that's not cut,listen up conservatives "says Dave" just be conservative,don't mention policy,just agree with the tabloids,that way we get in through the back door;then we implement the usual tory acts,tax cuts for the rich and 20Bn pounds less for our services.Oh before i go remember i'am Dave i'am green but blue through and through.
give the patients a cheque to take to where they can get the best balance of waiting time, cleanliness, and other factors for them
the nhs is crap because the end customer has had all the buying power taken away
free at point of need is a noble idea, but crap take it or leave it service is not
Hey Nick,
Having a good grasp of the english language you are surely able to ask more direct questions; than a rhetorical when will all this spin end,it doesn't it keeps going, or should I say growing?
We have this little principle of guilty by association, find out why our government is so prepared to ally itself to the criminal dictator George Bush...see how corupt that relationship is. Make no mistake friend, their propoganda is corrupting our judgement.
"In any event,there`s no evidence they`er committed to NHS cuts"
So here we have a tory party that has NEVER wanted the NHS,fought tooth and nail to stop it coming into being has said so many times that it should be in the private sector to give a better service to the people etc etc etc.Run the NHS in such a manner that something like BUPA can flourise.It is against everthing the tories stand for there words Nick not mine and you say...
"In any event,there`s no evidence they`er committed to NHS cuts"
No Nick there is however all the evidence you want that they want to destroy the NHS it is against everthing they stand for the strong survive the weak go under that is what they stand for that is there credo there very being.
On the 91Èȱ¬ news this morning a participant made the observation that money for medicines could be provided by withdrawing from Iraq.
Why does the 91Èȱ¬ introduce one-sided political comment of this kind.
There seems to be little point in posing the question. The possibility of thoroughly discussing a political matter rationally is nil; especially through the media with its varied ownership and interests.
Hi Nick,
I think you need to go on a journey to the hospitals which are being closed and talk to staff with twenty years experience who are being made redundant and convince them this is not cutting services.
The vast sums of money invested seem to have disappeared into the NHS with little to show for it in many areas.
Our local hospital in Grantham is facing an A&E downgrade forcing 100,000+ people into a 'golden hour' blackspot. Not being able to reach an A&E within the hour will kill scores of people each year but the trust must balance the books at these peoples expense.
Feel free to come up and see for yourself just why 'New Labour' have bodged the NHS in these areas you seem to have little knowledge of. I think you will then understand why the word 'cuts' is being used - as you surely don't know at the moment.
only this to add, all politicians should be made to read the comments that are here. Maybe, just maybe they would understand how the people of this country (uk) are feeling .
Blair is about to spend 76 thousand million pounds I will repeat that 76 thousand million pounds on a new Trident system that if the truth were known DOESN`T even have any warheads on it.Oh the SHEER MADNESS of existence that we can`t afford a health service.
I have experianced first hand the cuts in heasth services and medical staff, so dont try and say that cuts are not happening.