Monday, March 19, 2007


A 'damning' report on the NHS reveals that of £19bn extra put into hospital and community health services since 2003:

£6.6bn has gone on pay
£2.2bn on the rising cost of drugs, and implementing recommendations by the National Institute of Clinical Excellence treatment advisors
£1.6bn on hiring more doctors to comply with new EU employment laws on number of hours worked
£1.1bn on new buildings and equipment
£1bn on medical equipment and £600m on negligence lawsuits

leaving 'just' £5.9bn for direct improvements such as reduced waiting lists, much greater use of day surgery, larger numbers of doctors, nurses and consultants, and elderly patients spending far less time in hospital.

I don't understand why new buildings and equipment, more doctors and new drugs apparently don't count as direct improvements. Negilgence lawsuits are one of the hazards of every health service, but it is not a cost which can be avoided. I'm in favour of better pay for people who work in the NHS (in 1997 the starting salary for a nurse was £12,000, now it is £18,000), and personally I'd much rather the people responsible for caring for me if I get ill don't have to work excessively long hours or take on other jobs or have to worry about whether they'll be able to feed their kids.

Apparently the report is concerned that productivity has fallen, measured by in-patient admissions per nurse or consultant. This strikes me as a deeply stupid target. By 1997, two decades of starving the NHS of funds meant that, amongst other things, nurses' pay was too low, and many doctors were having to work much too long hours. Yet according to this target, addressing either of these problems is bad because it causes a fall in productivity.

The NHS has been in 'crisis' ever since it was founded, and it faces many genuine challenges today - an ageing population, rising expectations, how to get public involvement, how to reduce health inequalities, as well as some self-inflicted - such as pointlessly trying to turn it into a commissioning service. But the idea that the extra money has just been wasted and hasn't led to improvements is pernicious nonsense.


At 11:29 am , Anonymous Anonymous said...

The same people who are saying that the NHS hasn't improved (on some mythical measure that seems to depend on a set of variables including "are labour running it" and "how tory am I") were the same people who said that waiting lists were just a fact of life 10 years ago - and who were saying that standards of care could never improve in a publicly funded free service.

They were wrong then, they're wrong now. And those on the left who help to foster the impression that the government is doing down the NHS should stop and think for a while about the consequences of them succeeding in that endeavour - and maybe start to contribute to winning the real argument that's happening right now in this country - do you trust Gordon Brown or David Cameron on the NHS?

This post is a very welcome contribution on the side of sanity.

At 2:30 pm , Anonymous Anonymous said...

Why is commissioning a "self inflected wound"? Surely that is a big cause of the real improvements. The alternative to commissioning is to leave the trusts without competition and - as the last 60 years shows - the losers in that are the working class people with the poorest health outcomes already.

The biggest thing the government has done is told the fat cat consukltants of the BMA that there is an alternative to their shoddy service and the way they stack the deck in favour of their private practice - that is one of the underlying reasons these people are now whining about the Labour government.

At 2:54 pm , Blogger donpaskini said...

I would like to hear more about commissioning as a cause of improvements (anonymous will certainly know more about this than I do). All I was thinking of was the re-organisation of the PCTs (which is hard to argue as money best spent) and the push for the NHS to be a commissioner of services from a range of different healthcare providers, as opposed to delivering services directly. If the latter has in fact been a cause of service improvements, then a) great, and b) tell me more.

At 4:10 pm , Anonymous Anonymous said...

(I'm the first anonymous, not the second anonymous)

My understanding of why being a more aggressive commisionner of services rather than trying to keep everything in house has benefitted the NHS rather than wounding has been that to some extent it has un- "stuffed their mouths with gold".

I.e. I think it works that consultants used to be able to charge privately x amount when people went to them for treatment because the waiting lists were too long.
This was a good deal for them and there was little incentive to work hard and chop the waiting lists.

The government, in around 1999 or 2000 started the process, now expanded, of going to private providers and saying 'right, massive waiting list for this operation, we'll buy for y amount a thousand of these operations off you - take it or leave it.' they took it, and now the waiting lists have gone down people who might have gone to consultants privately and paid x amount are now getting the operation paid for by the NHS for y amount (less than x amount for a whole host of reasons not least the purchasing power of the NHS) and the privateering consultants have taken a pay cut, have ended up doing more NHS work and rationing is done far less on the basis of who can pay a private consultant and far more on the basis of who needs the operation.

Clearly this is hardly a perfect solution - but if it makes the consultants do more NHS work and less private work, and earn a little less along the way for waht is essentially a very very high paying profession then fair enough.

At 1:24 pm , Anonymous angus said...

"those on the left who help to foster the impression that the government is doing down the NHS should stop and think for a while about the consequences of them succeeding in that endeavour - and maybe start to contribute to winning the real argument that's happening right now in this country - do you trust Gordon Brown or David Cameron on the NHS?"

It's a shame, anonymous, that the government hasn't spent its time defending the efficiency of their spending record in the excellent way Dan has done-coupled with an effective populist attack on any Tory proposals for market reform as Labour did in 1997-rather than conceding the Tory argument by attacking the NHS as an inefficient organisation in need of a heavy dose of market reform. And then being attacked by the Tories for not going far enough.

At 8:17 pm , Anonymous JoeMc said...

Well said. You can join the anti-bullshit police Dan.
I'm sick of hearing people saying the government is 'wasting' money on nurses pay. You couldn't open a newspaper in the late 90s without hearing how poor nurses pay was. The rises were well overdue.
The productivity stick is also a bizarre one to beat the NHS with; if I, as a NHS Dr, spend twice as much time with a patient instead of rushing them out of the door then I instantly halve my productivity. Economic values such as this are only a small part of the bigger picture.
Where the government does need to be careful is wasting money on silly schemes to attract the private sector.....


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