Lansley's inflated sense of his own department's spending

Perry

the NHS will become too cumbersome and costly a beast

Well I guess that goes for the EUSSR too.

What’s good for the NHS goose is surely just, - if not more, - good for the EUSSR gander.

alexsandr

There is plenty of savings to be made in the NHS

1. Energy. Hospitals are heated to unbearable levels, even in the summer. and lights are on all day even when sunny. And no-one ever turns stuff off when not in use. Put in some saving measures to cut the energy bills for heating and lighting.

Look at the drugs for elderly people. As people age they get longer and longer lists of medications. Doctors should regularly review the total drug regime to see if it is all necessary , and preferably it should also be peer reviewed.
And, for instance, doctors should prescribe people to put their feet up and raise the foot ends of their beds to reduce ankle swelling rather than prescribe diuretics. A small lifestyle change will often improve health with no drugs so win-win.

But this requires lateral thinking, so probably wont happen. And the culture where no-one can criticise or question doctors needs to go.

ROJ

If an organisation is spending £100 billion, and is competently managed, then its ability to control how "inflation" affects its costs is quite considerable. There will of course be items, such as imported supplies, that will be affected by exchange rates. But elsewhere, negotiations on wage increases and with suppliers can make a big impact on the organisation's effective rate of inflation. Budgetting and financial planning in the NHS and throughout the public sector is made ineffective by the universal assumption that all budgets must automatically be increased by some standard rate of inflation.

To put it another way - we know that the CPI actually hits different groups of consumers differently. Why then is it acceptable to use a simplistic single rate in the planning of a £100 billion business. Do the managers of the NHS have a measure of inflation as it will hit the NHS?

Man in a Shed

So what's the rate of health inflation these days & the projected change in the retired population ?

normanc

Agree, the government should be consistent.

If they want to argue that health spending is increasing spending by £14bn then Cameron should tell us all he's cutting government spending by minus £80bn over this Parliament (i.e. increasing it by £80bn).

Not that I think increasing spending is the be all and end all, but that is how Cameron has decided to frame the NHS (his reason for being in politics!) argument so we are where we are.

Publius

'involving "town halls"'

Please for the love of God don't let my town hall be involved!

TrevorsDen

Come off it Mr Hoskin; do grow up.
We know that health spending is ring fenced. It is being maintained at 2010 levels allowing for inflation.

So? Whats the big deal in spelling out that that means an extra £11 billion.
I understand that the QT audience the other week booed when it was pointed out there were no cuts in health spending. You cannot blame Lansley for pointing out the increase in cash terms.
He needs to do it in fact.

The great leader himself said in Labour's 2010 manifesto ...
"An ageing society and so-called “lifestyle diseases” are changing the nature of illness and disease and mean improved health requires a far greater focus on prevention and early intervention.
Taken together these factors demand radical reform and change across the NHS if we are to meet the aspirations of the public to world-class healthcare. They require an increase in the pace of change."

Thats "radical reform" "across the NHS"... labour policy. [PCTs anyone? GP Commissioning?] And Labour promised £20 billion efficiency savings. Just like the coalition. Thats 17% of the budget - so clearly only 'radical reform' can make those kind of savings.

Fergus Pickering

Alexandr, you're certainly right about the drugs. I am an old person and they shower drugs on me. Some I need to keep me alive. Most I don't. I think everybody should PAY for prescritptions, children, old people, everybody. That would cut down the amount at a bloody stroke. But the British Public would never stand for that. I also think people should pay to see a doctor. But they wouldn't wear that either. And pay for food in hospitals. I was in for a procedure and I got a free egg sandwich. Very nice too, but I meanter say. Why SHOULD healthcare be free. Affordable maybe but why free.

Mind you, I'd have parents paying school fees too.

perdix

Well said ROJ.

TrevorsDen

Alexandr / ROJ --- there is a NHS programme called QIPP; look it up.

It is all about the best way to make savings, from applying best practice across the whole NHS to buying toilet rolls cheaper.
The NHS is doing what you suggest. People should think before they assume.

the big question is this - if labour thought it was OK and safe and possible to make savings totalling 17% of the NHS budget and not affect services (indeed improve them), then why was the money spent in the first place?

Magnolia

Mr Landsley failed on several accounts.
He never explained to the public how much quality destruction went on in the NHS under Labour.
Contrast this with education and welfare where the respective ministers took the fight to Labour and largely won the argument with the public.
He is repeating Labour's mistake of giving everything to GPs who have already had their mouths stuffed with gold under Labour.
He's repeated the vacuous phrase of 'no decision about me without me' which means not a lot when his reforms give all the power and control to the GPs and not to the patient and their own choice of doctor or health provider.
There are big quality issues with the health service and probably big affordability issues but the public will not swallow it if mountains of cash from 'savings' are shovelled abroad.

Mirtha Tidville

The simple truth is that the NHS is out of control. Its too big, unwieldly and has far too many layers of non productive management.
Our local Hospital used to proudly display the picture of a `Patient Services Manager` who was being assisted by 2 deputies and God knows how many staff. Whats that about then???

Lansley is making a start,many may say its not enough or the wrong way etc but someone, sometime has to start the process of pruning. I wish him much success.

Someone above mentioned changing the culture of `Doctors cannot be challenged` which is something thats needs to be done urgently. I for one have more confidence in the Vet....

Scary Biscuits

These assumptions about inflation are very lazy.

If you are a business under pressure and one of your suppliers says his prices are going up by 5-20% this year (as they are for the NHS) then you challenge that supplier or search for a new one.

There is no good reason why '£114 million of today's money will buy fewer ambulances and hospital beds than it does now'. If you don't believe this ask what car £10k will buy today compared with 10 years ago - if the private sector can provide a dramatically better car at much fewer pounds per mile (effectively negative inflation even after petrol doubling in price) then why can't the NHS do it?

(The answer btw is the absense of competition, exactly what Lansey is trying to introduce.)

Nicholas

alexsandr - indeed this won't happen. Modern Britain is all about soundbites, words, faux outrage and "something must be done" clamouring, etc., but duty, responsibility and above all circumspect maturity are long gone. The population has been infantilised, has the attention span of a gnat and superficiality beyond belief. The nation is gripped by the values of lower middle-class, vain, rather unintelligent but opinionated women who want new kitchens but who would march in the streets if anyone dared to suggest they should stay in them and shut up (q.v. "mumsnet"). As a masculinist in the struggle against the tyranny of feminism, when the BBC put on a programme called "Solid Men" to balance the obscenity of "Loose Women" I'll be happy to retract that comment.

Anybody who tries to raise a serious issue and uses the wrong words receives an onslaught of politically correct outrage from all the vociferous minority pressure groups that now rule us. The only obsessive subject for which all the stops are pulled out is the protection of children against real, imagined or hyped up dangers.

Simon Stephenson.

This is the relevant section from Mr Lansley's article:-

"Without change, and despite the Government’s provision of an additional £11.5 billion in funding, the NHS will need £130 billion by 2015 – meaning a potential funding gap of nearly £20 billion a year.

Fast forward to 2030, and the projections are even starker, with the number of over‑85s set to reach 3.5 million, or 5 per cent of the population. Based on these projections, the NHS would need to perform an extra two million operations.

Put simply, if things carry on unchanged, this would mean real terms health spending more than doubling to £230billion. That is more than £7,000 a second – twice as much as we are spending today. This is something we simply cannot afford."

It strikes me that the spin-doctors could have worked in the "hurrah" phrase "the Government’s provision of an additional £11.5 billion in funding" without occasioning the need for such a mishmash of nominal and infation-adjusted figures.

Of course, if the spin-doctors hadn't insisted on portraying the ring-fencing of real health spending as such a noble, adequate and pain-free policy, we might not be having to address the real situation with so many minds believing that, once again, they've been conned by the politicians.

ROJ

TrevorsDen - thanks for the tip about QIPP. I did look it up and this is what I found:

"QIPP is working at a national, regional and local level to support clinical teams and NHS organisations to improve the quality of care they deliver while making efficiency savings that can be reinvested in the service to deliver year on year quality improvements.

QIPP is engaging large numbers of NHS staff to lead and support change. At a regional and local level there are QIPP plans which address the quality and productivity challenge, and these are supported by the national QIPP workstreams which are producing tools and programmes to help local change leaders in successful implementation."

Anyone who thinks that this kind of jargon has anything to do with controlling costs does not know much about management. Looking at the national QIPP workstreams, for example, these seem to be not a lot more than working parties prescribing motherhood. In real life, costs are saved by managers who pressed by the culture of the organisation in which they work to achieve the same outcomes with the same cash budget despite "inflation". They find a way. That kind of corporate culture is a million miles away from the approach of a bureaucracy like the NHS, which pays lip service to finding efficiency savings by setting up another internal bureaucracy like QIPP. Then of course the NHS publicises QIPP so that TrevorsDen can reference it.

BenM

And like much else in Lansley's bill, talk of "fundng gaps" is massively disingenuous.

The only reason there would be a £20bn shortfall in funding of the NHS is if the government CHOOSES to underfund the service by that much.

The government could easily choose to fund the gap - and more - if it so required. These are all choices. Lansley and the Tories are making the wrong ones.

Tories are more likely to choose to underfund the NHS by this amount - which is why they're not trusted with the service by the British people.

HJ

The first measure that the government could easily take is to re-negotiate the GPs contracts and to reduce consultants pay to similar levels to the rest of Europe.

The limits on entrance to medical schools could then be lifted so that we have a ready supply of medics at lower salaries in the future. At the moment, thousands of qualified applicants are turned away.

Tanino

Wages are being freezed and nobody says that ambulances will rise in price with inflation.

John Staples

The issues Andrew Lansley are real and serious, and demand some serious answers.

The way he has gone about answering those issues - with rushed, complicated, top-down structural reforms which were hidden from the public at the last election - is an object lesson in how not to do it.

He is the wrong man for the job.

Conservative Libertarian

By trying to "include" the "real costs" with regards to inflation you become part of the problem. By borrowing/printing more money you create an inflationary loop which feeds upon itself.

The money isn't there. We don't have it. Making cuts to live within our means is inherently deflationary. But if you keep buying the: "costs are rising so spending must too" argument you'll never escape the deadly circle.

David Lindsay

In today's Daily Telegraph, Andrew Lansley professes himself open to "substantial alterations" to his barking mad Blairite scheme to dismantle the NHS in England, while today's Daily Mail front page denounces both private equity and the privatisation of care services (in fact, like so many of these things, merely the issuing of the nastiest of private companies with licenses to print public money).

When will there be a political party to give voice to the opinion of most Telegraph and Mail readers, of most habitual Tory voters, and of most Tory councillors and activists, out here in the country at large? Previously confined to Neil Clark's column on the Morning Star, as of today it is apparently the editorial position of the Daily Mail. That newspaper might start campaigning against Loony Right councils, as once it campaigned against Loony Left ones. It could start with Birmingham, which is outsourcing municipal jobs to India.

There are those who, since even the forced nationalisation of several leading banks could not convince them, are certainly not going to be convinced by the nationalisation of a network of care homes whose bills are already paid by the council. But even so, how much longer is the swivel-eyed privatisation, globalisation, worker-bashing and war-mongering of the lost generation that began with the death of John Smith going to be presented as "the centre ground"?

Ed Miliband, over to you.

Robin Hoyles

I despair of all politicians and the NHS. Until reducing expenditure on the NHS becomes the aim instead of increasing it, the NHS will just continue to be over bloated, inefficient and expensive.