This is yet another post on the repercussions of the Comprehensive Spending Review and its implications for the NHS. It’s been interesting that since the review was published there has been more press comment on the belief that the NHS is going to run out of money than any of the public services that were actually cut. This is a genuinely puzzling psychology.
I spent a small part of the week with a theatre company. The Arts Council has announced 30% cuts for most of the organisations that the Council funds. The larger national organisations suffer 15% but the smaller regional companies suffer twice that amount. The organisation is looking at ways of developing its productions rather than cutting them.
But most of the last week has been spent with the NHS. Much of it spent looking at whether the ‘real increase for next year’ is going to be a REAL increase at all. Whether the money taken from the budget for social care coupled with the use of the Treasury Deflator means that the NHS budget has actually been cut by 1% or so.
I am sure this does matter – after all 1% is a billion pounds, but when you are surrounded by a public sector that is being cut by 26%; when the navy is building an aircraft carrier that for years will have no planes on it (technically of course this will not be an aircraft carrier but a floating football pitch), the NHS is really doing OK when compared to others.
If in, 14 months time, we have thousands of people waiting for hip replacements for more than 6 months; if at the time there are 10 hospitals who cant pay the wages, and if there are 20 PCTs preparing to hand on half a billion pounds of debt to GP commissioners, then the public are going to wonder what planet the NHS lives on. It’s true that people will blame the government, but many of them will look at the NHS and think that this organisation is really troubled.
I took part of a breakfast seminar meeting that was on TV. Not BBC1 , not even BBC6, but a thousand or so people watching Policy TV. We had a panel that were there to discuss how the NHS was going to cope at the same time with financial pressures and a reform programme over the next 18 months. Most people were very gloomy.
Nick Bosanquet has the long term perspective which is to predict that the NHS is now facing its fifth financial crisis where it runs out of money. .He even predicts when this is really going to hit – on November 1st 2011 (Best not to get really ill next autumn).
He feels that the NHS does not have the flexibility in its organisations and relationships to really save the £20 Billion that needs to be saved over the next 5 years. Most of the panel and the audience agreed with him. Of the audience he was the only person who felt that GP commissioning would actually work and in that belief he made a very important point about scale.
The problem for the NHS is that it is used to talking in such large sums of money that no one can really comprehend them. It really doesn’t mean much to the general public to say that we spend over £100 billion on the NHS. It doesn’t really mean much to say that we need to save £20 billion over 4 years. Similarly when the cancer drugs fund is set up for £200 million people saying it’s not enough is, at best, odd.
It’s not just that these enormous sums of money are beyond real human comprehension. We have got used to talking about the economics of the NHS with sums of money that have no meaning. The danger is that therefore money has no meaning. .
From the other end of the telescope, GPs will be interested in an extra £71,000 for an improved service for people with diabetes, an extra £35,000 for a re-enablement service for the frail elderly.
Those of us from the land of BIG see these sums of money as too small to bother with. The land of BIG thinks it is vital that GPs learn to talk in tens of millions of pounds – then they will be serious players.
But this is probably the wrong way round. Everyone in the NHS needs to recognise that for most people tens of thousands of pounds is a lot of money. We need people to manage health economics that think in terms of these sums of money and not in only multiples of tens of millions.
The benefits that will spring from any new economics of health care will be accrued in parcels of tens of thousands of pounds. The NHS will only thrive if it learns to accrue improvements in efficiency by saving tens of thousands of pounds, tens of thousands of times.
It may be that GPs will understand that better than all the DH finance experts.
It is just not possible to really comprehend, and therefore achieve, savings of £20 billion in one go.