Andy says Andrew will cut access to cancer diagnostics by abolishing targets. Andrew says Andy will cut access to local services by closing local hospitals. Norman says he’ll cut the NHS budget, but won’t cut services. All the main parties are agreed that cuts are an issue and all agree that the NHS faces a funding gap over the next few years. Yet all are equally adamant that their policies will avoid damaging cuts to frontline services. Are they all correct? Are any of them correct?
Although each of the parties has pledged to protect health spending (to varying degrees), it seems clear that the NHS will have to embrace austerity. No doubt NHS managers will have viewed with some concern the pledges made by the various parties over the past few weeks.
Implementing Labour’s guarantees and introducing access to ’8 to 8′ primary care will not come cheap. For the Conservatives, the moratorium on hospital closures and the promised cancer drugs fund – both popular on the doorstep – will restrict NHS managers’ room for manoeuvre when it comes to identifying spending. The Liberal Democrats are committed to introducing directly-elected Local Health Boards. As structural change (and elections) don’t come cheap, it has to be assumed that this move will, at least in the short term, add to the cost pressures facing the NHS.
So where can the money be saved? Three areas spring to mind where big savings could be made, although none will be a politically easy option. Although ‘cutting bureaucracy’ resonates with the public, it is difficult to achieve in practice. All three parties have made predictable pledges to streamline management processes, but the actual savings which will be achieved by rationalising Arm’s Length Bodies are likely to be relatively modest. Real savings will require more fundamental restructuring. Labour may be committed to no more ‘top-down’ restructuring and the Conservatives are opposed to ‘pointless’ reorganisation, but there is plenty of wriggle room in these commitments. Do not be surprised to see ‘bottom up’ mergers of PCTs or changes to organisational structures which definitely have a ‘point.’ These changes, however, will be opposed by many in the NHS who have grown tired of repeated reorganisations and will argue that reorganisation – pointless or otherwise – essentially blocks service improvement for several years.
With staff costs making up such a major part of the NHS budget, it seems inconceivable that the next Secretary of State will ignore workforce issues, even if tough decisions are left to ‘local decision-making.’ A brave Secretary of State may even seek to renegotiate staff contracts. Either way, there may be some tough conversations with the unions ahead and the next incumbent of Richmond House would do well to remember that, although the media don’t like ‘fat cat’ GPs, the public remain remarkably loyal to the healthcare professionals who help them when they need it most.
Finally, the next generation of ministers may look to payment by results as a means of imposing cuts without being seen to slash services. The current tariff has been frozen representing a real terms cut. A courageous Secretary of State could go further, actually deflating the tariff to encourage more efficient care, driving some services into the community in the process. The unspoken implication of such a move is that it will make some hospital services uneconomic, adding fuel to the flames of local hospital closure rows. Of course, further increases in tax could always help fill the gap. Given the pressure that would face the rest of the public sector, it is however debatable whether any of this funding would find its way to health. With this range of options before them, it is little wonder the parties remain keen to spell out the implications of their opponents’ choices than they do their own.