Has Osborne downgraded the Tories' commitment to ring-fence health spending?

Liz Brown

Can we please revert to that good old fashioned word COVER - why has "coverage" suddenly become le mot des jours? I detest it.........

david

So its OK for Tories to tell lies is it?

Minnie Ovens

Gosh, this really assures me of the Tory's committment to a principled position on the NHS.
Well, for one second at least.
It might be expedient to wait until polling day to determine the Conservative Manifesto, but then it could change by the end of the day!

TrevorsDen

I think 'working hard' means getting value from the other departments which will bear the brunt of the cuts needed to keep health sacrosanct.

Simply saying 'ring fence' is not a solution in itself - what you have to do is what Blair and Brown failed to do over 12 years - deliver.

Knut

The Coffee House seems to have moved from Mandymania to NHSmania. It's getting a bit thin now IMO.

TrevorsDen

BTW - I count 42 angels dancing on the end of your pin.

seb

New Labour's NHS -
Hordes of management consultants running our hospitals. Inconsistent levels of patient care in different parts of the country. No credible system to prevent gargantuan levels of waste.

Just how difficult ought it to be to run a more efficient NHS? Some say that the NHS is an out-of-control empire. If so, then it's an empire that needs to be invaded and refashioned into a responsible branch of the public services.

Rhoda Klapp

Downgrading the pledge would be far far more damaging than anything Hannan could do. If they did it, the useless tories would prove that they can't even handle the gutless game they have chosen as their stratoegy.

Jeremy

I think it is clear from the twitter brouhaha that most people in this country value and respect the NHS as a Great National Institution. In one way or another, most of us have benefitted from the free healthcare which it provides and so have our parents and grandparents. Clearly, then, there is no electoral advantage whatsoever for the Tories to be seen going into the next General Election as the party which cannot be trusted on the Health Service. I am quite sure that Dave understands this.

Having said that, it may also be true that in the longer run there will have to be structural reforms of the NHS in the interests of value for money and the sound management of the nation's finances. I am quite sure that Dave understands this, too.

But his task will be to persuade the public that the Tories can be trusted to protect the fundamental principle of the NHS - that it is free to the user at the point of access - whilst also undertaking such structural reforms as might be necessary in order to ensure that it works properly, represents good value for the taxpayers' money which is spent upon it, and is kept firmly within the bounds of what the nation as a whole can afford.

As for "International Development", I really cannot see the point of giving away taxpayers' money to nations which are rapidly becoming richer than ourselves. Perhaps "International Development", like charity, should begin at home. And I am really not convinced about the morality of government giving away to foreigners the money it has raised from the nation's workforce through taxation. Donations of this sort should be made on an individual basis. It is not the business of government to be pumping taxpayers' money out of the country.

Minnie Ovens

seb
August 15th, 2009 10:14am

I agree with you but it is a hell of a task. It's bad enough reorganising something coherent but the NHS is incredibly bloated and you have the P.R. nightmare of someone dying in the midst of a reorganisation.
Possibly best to take on one hospital at a time, separate it out on its own and then do a very careful "trial and error".
It might also be of use to have a working knowledge of how it was manned in the fifties.
On the other hand it might be good if they looked at the GE or P&G organisational models to see how to run small companies flexibly, with their own P&L, but with the oversight of a corporate body.

RobertD

The Tories need to get something more distinctive than just" we will protect the NHS as it is".

The first presentional thing they could do is to take healthcare out of the big "tax and NI " pot and make it a distinct funding stream.

People need to understand that this is a clear element of social insurance where everyone pays in proportion to their income, and everyone gets according to their clinical needs.

This has the advantage that it creates a direct link between national income levels and the funding available to healthcare. As people earn more they pay more. If national income does not grow then the NHS will have to live within what people can afford, or there has to be a consensus that people are prepared to pay a higher proportion on their income. NHS funding becomes both more transparent, and less open to political interference.

The second thing that they need to do is to identify what they will do about two major areas where the NHS is spending increasingly large amounts of money, and where it could spend so much that it bankrupts the whole system.

The first concerns the relatively discretionary elements of provision, whether than be social treatments (some cosmetic surgery, IVF, etc), nicer surroundings (private rooms etc), or greater convenience (longer opening hours, faster appointments etc)

The second concerns end of life treatments where increasingly additional life can be obtained at great expense using the most advanced surgery and drugs, but where the only people to benefit are the patient and their immediate family.

More spending on both of these areas would make the service better and many people's lives longer and more comfortable. However to provide all of this for everyone becomes a bottomless money pit that most people are not willing to pay for through their taxes. They might however be prepared to pay if they can see a direct link between payment and personal benefit.

The solution is, rather than taxing the economy into a standstill trying to fund the impossible, to have an NHS that provides a good basic standard of care with all the essential treatments provided free at the point of delivery, and to make it easier for people to top-up the care that they get either through additional insurance (NHS supplementary plan or private) or direct personal co-payment for better facilities, faster access, and expensive life prolonging treatments.

People than have a choice. Pay only the minimum, and accept the core NHS service, or top-it up in order to get whatever service improvements that you personally want.

The social cohesion element could be protected by allowing NHS run top-up packages paid for on an income related premium, with a surcharge on private insurance / treatments that go to subsidise services for those on low income who make the effort to contribute to a top up package.

Finally there needs to be a mechanism to claw money back from those who abuse the system through neglect or deliberate actions. People turning up at A&E damaged through drink or drugs etc should be made to pay for their treatment in full.

It is not enough to protect a 60 year old museum piece. It has to be developed for the next 60 years. It's time to present a bolder vision. We have consumer choice in most of our lives. It's time to introduce some into the funding of healthcare.

AAE

In opposition, Cameron has been playing against an open goal and even now his fanzine is reduced to reading the Tories tealeaves in the hope of finding anything that might vaguely resemble principled policy. And according to The Spectator's editor, Osborne is to be the chief architect of Cameron's victory - dear oh dear. Is there not one millionaire in the Shadow Cabinet who understands that a state controlled monopoly can never in any way serve those who need it? And in passing, can anyone give an example of any state service which actually does what it says on the tin? For years in this magazine Christopher Fildes would tell us that if a private individual spends £1, he will get £1 of value, but for the government to get that same value it needs to spend £2, and that is only at best as countless projects come in at ten or one hundred times over budget (how is the NHS IT system coming on?). In 4 years Cameron has given no hint that he would like to de-politicise spending or for that matter release us from any of the tentacles of socialism and all the while surrounding himself only with the exceptionally privileged - poor political judgement, poor economic judgement.

PSJ

Never mind the NHS - why the hell is international development - giving our money away to foreigners - ringfenced?

Verity

Jeremy writes: "... most of us have benefitted from the free healthcare which it provides."

Free? Excuse me?

When your insurance claim to get your car repaired comes through, do you think you have had your car repaired "free"? Or do you think your insurance premiums paid for it?

As I and several other people keep saying "Look to the French and the Singapore systems". And for people who have never made a contribution, i.e., foreigners and layabouts, they should be charged for treatment at the going market rate.

I do agree with Jeremy, though, that funds for "international development" should be made on a voluntary basis by people wishing to contribute to Mrs Mugabe's Paris shoe bill. The days of state-mandated funds for "international development" should be ended.

Hysteria

what RobertD and AAE said

Verity

"In 4 years Cameron has given no hint that he would like to de-politicise spending or for that matter release us from any of the tentacles of socialism."

Well said, AAE.

I would go so far as to say I don't think he even understands that he is proposing extending socialist policies ... with his chimeric "global warming" agenda for a start. I don't think Cameron is the brightest light in the harbour. I don't think he's stupid; but he is certainly not intelligent enough to be a head of government. He had found his level when he was the head of pr for a TV company.

Frank P

As always Mark Steyn's diagnosis is spot on: http://www.ocregister.com/articles/life-expectancy-health-2529244-say-good

drakes drum

AAE observes correctly what many others are writing, and that is the total absence of any real strategic thinking and planning in the head of Cameron and his toffs.

Osborne in this article appears to be singing from a different hymn sheet from Cameron.

But that is standard Blair tactics.

Cameron's hysterical outburst over the NHS, most certainly does not help those of us attempting to understand the mind of this man.
Even the SUN, Mail and Telegraph had to warn, today, that the NHS is certainly not above criticism. Cameron has created this mess.

It really does pose yet another question mark against his leadership abilities. A leader must be calm in a storm. Can anyone, hand on heart, see that quality in this man?

Then one should never criticise colleagues, in public. A quality many fine sports managers display week after week.

Hand on heart- can anyone see that quality in Cameron?

Leading by example - well I suppose everyone followed the leaders lead in the expenses scandal- but can anyone identify any example of this man leading by example?

Then we come to courage. I believe Cameron to be a bully so I do not see courage appearing in his personal qualities. BUT I would love to be shown examples of this mans courage.

Like Heffer, I prefer my tories in the mould of Norman Tebbit. Cameron and co are not tories!

JohnAnt

It is depressing that almost every time Cameron or Osborne opens his mouth, he makes some remark calculated to play with Mr/Ms NuLabour.
And how does Osborne manage to look younger with each passing month? He started off as a sprightly 12-year old, but his features seem to be regressing back into prep school choirboy.
Is he Dorian Gray?

Malcolm

Reform of the NHS should be at the top of the agenda. A really thorough clear-out of its bloated and hugely expensive bureaucracy would be a promising start, and would release valuable funding to go where it is needed - the patients. At the moment I have the strong impression that parts of the NHS are there purely for their own benefit - a view that is reinforced by a nurse in the family. Nothing should be off limits, so it's time the Cameroons showed some real courage and led the long-overdue debate on this subject. Heaven knows, NuLiebour has provided them with enough evidence of waste and inefficiency over the past 12 years. Take the fight to them!

Verity

Malcolm: so it's time the Cameroons showed some real courage ...

Ha ha ha ha ha ha! Cameron, as the officially endorsed Heir to Blair cannot take the fight to them. And nor would he want to. He's with the programme. Yes, twiddling some knobs and fiddly bits, but he's not about to mess with the NHS.