Health Matters | Paul Corrigan's blog

Regular readers of the blog will not be surprised that I am returning to the problem of the Government’s narrative about the NHS. What story is it trying to tell?

Part of the problem it has had with its failed NHS narrative results from the success of its narrative regarding the economy. Both before and during the last election the then opposition attacked the then Government for spending too much money and building up debt.

Then, when they gained power, both parties in the coalition began telling the same story. The government had been living beyond its means and they needed to cut back on public expenditure so that between now and 2015 we could balance the books. Despite the protestations of a few arguing for the need to increase public expenditure to create more demand and consequently more jobs, the majority of the population bought into the message that as a nation we had been living beyond our means. We needed 5 years of the tough medicine of cuts to put us back on the straight and narrow.

But there were two exceptions to the new Government’s narrative about the necessity for cuts. Public finance spent on international aid would not be cut and expenditure on the NHS would be protected.

There may be some readers who find it odd that these two very different aspects of public expenditure should be the ones chosen for protection. What are the economic and social links that bring these two very different aspects of Government together?

The answer is of course nothing – or rather nothing economic or social.

The only thing that unites these two areas of public expenditure is that both are ones that traditionally Tories would instinctively want to cut. Therefore if, as the leader of the Conservative Party, you needed to distance yourself from traditional Tory instincts you will ‘protect’ those areas that traditionally would have been cut.

As a result we now have a Conservative-led Government which has cut police numbers and is building an aircraft carrier – but cannot afford the aircraft to fly from it. Yet at the same time it is maintaining expenditure on the NHS and international aid. This is good counter-intuitive politics.

So the NHS was to have been protected for very good political reasons.

But then comes the NHS reform programme and for some months it is a programme in need of a reason for its existence. After a few months of meandering through different narratives, the reform programme keeps bumping into the importance of reform to ensure the affordability of the NHS.

So quietly we have a narrative developing around the necessity of reforming the NHS – simply so that it can continue when there is less money around.

This is a really good narrative. There are some problems of detail – such as why will GP-led commissioning be better at creating a new affordability than PCTs? – and what on earth will clinical senates have to do with making the NHS better value for money? (In fact what on earth do clinical senates have to do with anything?).

But at least, and at last, it is a narrative.

Then this narrative is compared to the bigger, louder, economic story which says that public expenditure has to be severely cut – but that the NHS will be ‘protected’. The public are quite rightly relieved to think that the NHS is protected – at least the NHS will not be worried about money.

But then the public are told that in fact ’protection’ does not mean that the NHS will not have to endure cuts in some services.

This clash between the Government’s narratives has left the public puzzled about what it is actually doing with the NHS?   Does the NHS have to be a part of the general economies of the nation? Or is it protected?

The Chancellor’s autumn statement changed a lot of basic beliefs.

It admitted that the deficit will not be cleared before the next election. For the first time it acknowledged that this is not a short term problem (and in fact if there is a recession next year and no growth the year after, the clearing of the deficit won’t happen until almost the end of the decade). The deficit is here for quite a while. There will have to be more cuts.

As I have commented in previous posts the people in the NHS with whom I work are usually in their 50s and having to make personal long term decisions about their household economics that recognise that their children will probably be poorer than they are. This is a long term economic crisis and we are all beginning to learn to think about our futures in a different way.

Yet in the midst of all this the Government is still saying that the NHS is protected. All other expenditure is in a mess – but not the NHS.

As I said the other day in the recent Government paper on innovation David Nicholson, for the first time, says that ’for the foreseeable future’  the NHS will only have the resource that is has now.

Yet whilst the Government has changed its public expenditure narrative, it is sticking to the idea that it is protecting the NHS.

This will become increasingly confusing for both the NHS and the public. At some point soon, if the NHS is going to survive, David Nicholson is going to have to say that the ‘Nicholson Challenge’ will continue after 2015 – and that it may be a bit of a stiffer challenge. This needs to be said to move the NHS away from the belief that this is one last heave for a few years before we are back to the land of milk and honey.

But if he says that whilst the Government is insisting that it will protect the NHS it will be deeply confusing for the public.

What we have here is an historical clash.

Politically the Prime Minister has to keep insisting that he will protect the NHS.

His Chancellor needs the NHS to provide much, much better value for money.

The more talk there is of protecting the NHS the less likelihood there is of making the changes needed to develop much better value for money.

Next year will see the clash between the political necessity of Conservative NHS  policy and the economic necessity of its public expenditure policy.