The Maynard Doctrine: Time to get real: “protecting” the NHS budget is impossible
Professor Alan Maynard OBE wonders whether the politicians vowing to protect NHS budgets are deceitful or stupid. He outlines the main options for the NHS to save some money.
Two of the main political parties have managed to keep the NHS off the election agenda by saying that they will protect and continue to grow its funding.
Is this downright deceit? Or merely the misguided hopes of optimists?
Safe hands holding the legacy of Tredegar bedpans
Both the original frontrunners for government, Conservatives and Labour, genuinely seem to believe what they are saying:. in Thatcherite rhetoric, the “NHS is safe with us” (she never actually said “safe in our hands”).
True, Labour have had McKinsey’s in to scribble on the back of their well-worn envelopes and decree that the NHS needs to recycle £15-20 billion to meet the demands of the ageing population and the avarice of the pharmaceutical industry -currently offering the NHS few health gains from new products at excessive prices.
Such recycling requires major productivity gains. This has occasioned a plethora of unevaluated innovations applied hastily across the NHS, rather than piloted and appraised with due care.
Betting on the untried and untested
CQUIN at national, SHA and local levels is putting hospital income at risk. The assumption is that these CQUIN process targets will be fulfilled. Will they? What if they are not, and hospitals are driven into bankruptcy?
’The assumption is that these CQUIN process targets will be fulfilled. What if they are not, and hospitals are driven into bankruptcy?’
What gains to productivity will they produce? Is there a risk that we will get more widgets (i.e. activity) at higher costs, rather than the desired better outcomes at lower cost?
Similar queries need to be answered about QIPP and the downward squeezing of the tariffs. Stirring the magic porridge pot of NHS activity may give us safer healthcare with less variation in clinical activity.
But it may also slow activity, continuing a trend evident in consultant activity data for the last decade.
’Whilst applauding the fact that the Department of Stealth has finally begun to use financial incentives more creatively, the current enthusiasm is hasty and poorly evidence-based.‘
Will all this stirring of the pot really free up McKinsey’s magic numbers? Faith-based policymakers are currently on their knees to Jerusalem or Mecca, hoping that God in all her / his majesty will produce what Sooty’s magic wand has failed to do in recent years: greater efficiency in spending £105 billion.
Whilst applauding the fact that the Department of Stealth has finally begun to use financial incentives more creatively, the current enthusiasm is hasty and poorly evidence-based. There is a risk that these blunderbusses will undermine non-financial incentives, in particular the desire of most workers to do a good day’s work.
But what else can be done? It is important to note that the Liberal Democrats have offered no guarantee of funding. Instead, they recognise the need to prioritise within and between all Departmental budgets.
The safer financial surgery checklist
What NHS activities could be culled?
’Slashing the Department of Stealth’s budget will further impair its ability to monitor the NHS, especially if its spend on consultants is cut as promised from the current level of over £100 million a year’
Whoever gets into government there is likely to be a cull of QANGOes. The challenge will be to ensure that this exercise is real, rather than the mere merging of existing organisations.
Slashing the Department of Stealth’s budget will further impair its ability to monitor the NHS, especially if its spend on consultants is cut as promised from the current level of over £100 million a year.
Abolishing the SHAs is appealing to some, as their performance is very variable.
Merging PCTs is inevitable, particularly if the Tories wish to turn them into autonomous insurers, thereby emulating the Netherlands.
The disruption of redisorganisation, once budgets cuts become essential to keep the bankers happy, will make many a manager quite ill!
But what are the alternatives?
There is an alternative - apart from wage cuts and sacking employees. This involves some difficult issues, however.
Public expectations inflated during the Blair-Brown bonanza may have to be managed down. This is code for ‘citizens being asked to bear pain and discomfort for longer’ by e.g. changing treatment thresholds and asking citizens to wait longer for care.
Cutting supply
How else can demand be reduced? The classic solution is to cut supply, and make rationing more challenging. The hospital bed stock is already quite low by international standards. Can it safely be cut further?
This takes us back to the opening issue: is the debate about the future of the NHS just plain deceitful or based on misguided hopes?
’The cuts programmes will be incremental and vicious. But they cannot come as a shock: they have been forecast for nearly two years.’
Watching the coverage of possible closure of some facilities at Kingston-on-Thames and Tory promises about maternity units and emergency departments mean that come late May, lots of folk will be very disappointed. They will be fed the usual horse manure: ”now we have seen the books, the economic situation is far worse than we feared”, etc!
And closures will follow with mergers.
No surprises
The cuts programmes will be incremental and vicious. But they cannot come as a shock: they have been forecast for nearly two years.
The nice issue is whether NHS management will surprise local populations and protect services whilst being pressed by politicians and their acolytes to slash and burn, to ensure the IMF does not take over our national finances.
Hopefully, Britain can emulate the Irish and the Baltic countries and avoid social unrest as its citizens face up to recovering from a decade of bingeing, funded by other countries through the bond markets.