NHS resources and how to use them – for 2010 onwards
Filed Under (Expenditure, Primary Care Trusts, Public Health) by Paul on 18-09-2009
This, the second week in September 2009, has given us greater clarity about the resources that will be available to the NHS over the next few years whoever wins the next general election. There are two sets of milestones that will make this clearer and more specific, but the direction from both political parties is clear.
The certainties of the direction need a great deal more precision to allow individual NHS organisations to create a budget but there is certainty about two main issues.
- Both political parties recognise that there will be a very different overall pattern of expenditure in the next few years. Departmental public expenditure as a whole is going up by 6.4% this year and from next year the certainty is that it will not increase by anywhere near that much.
- NHS expenditure has been rising for the last 8 years faster than at any time in the history of the NHS and from 2011 it will increase by nowhere near that much.
Such a direction may not give managers much help but let me make a number of comments about the general way in which the NHS is used to working that will not be the case in a year’s time.
1 This week the HSJ reported that GPs will get £5.25 for every swine flu jab they administer. If they treat 20,000,000 people it would increase their income GPs by £100 million for the year.
If there is a pandemic in a year’s time GPs will not get paid an extra £100 million to give the public flu jabs. The money won’t be there. It will no longer be possible for the DH or the NHS to buy its way out of getting important things to happen. Not only will the money not be there, but public opinion will not be support giving GPs £100 million to stop the nation from getting ill. The vast majority of people in the country will expect GPs to help the nation stop a pandemic as a core part of their job.
If the money is not there and GPs refuse to do it as a core part of their job, then whoever wins the next general election will have to appeal to public opinion to support the belief that it is. If GPs refuse to see it that way and don’t give the jabs when people start to get ill, there will be a serious public backlash. Putting the demand for extra money before patient care will not be a popular rallying cry.
Throwing money at the next pandemic will not be a medical option. The next pandemic will not be fought with extra resources. It will have to be fought with the existing resource.
2 One of the obvious issues causing the public anxiety, and the NHS money, is the postcode lottery in prescribing. Taking each decision one by one, PCTs see the obvious outcome that more drugs means more cost so this can’t be a part of a cost package. However, at the moment the variation in prescribing by PCTs is enormous. If you look at the amount PCTs spend on prescribing per weighted head of population it ranges from £85 to £192 per person. Now I know that weighted costings can vary, given the real world of different PCTs demands, but this variation is more than double! We have known this for some time yet all the urging in the world has had no impact. We also know that moving a lot closer to the average of £151would save £600m a year.
So postcode lotteries are something the public doesn’t like, and something they don’t like is costing them, and the NHS, £600 million.
Again, in a year’s time if there is a Secretary of State that wants to tackle this sort of cost issue, they will find the public on their side.
The important thing for a government that needs to save money within the NHS will be to do so with the grain of medical and public opinion. Over the next few weeks I will explore how this could be developed both in both a national and a local way on this blog.
