Which is the more alarming spectacle: David Cameron and George Osborne promising real term cuts in public expenditure (but not “swingeing” ones) in the coming Parliament? Or Gordon Brown behaving as if he can carry on making new spending pledges for the NHS?
I sometimes write that there is a rare degree of core consensus between the main parties on the NHS and mean it as a compliment
Honest readers can legitimately have different responses to the proposition. This week Brown signalled that up to 1.6 million cancer sufferers will be offered free one to one care at home by a specialist nurse. The £100m annual cost would be offset by our old friend, savings achieved via avoidable hospital admissions.
It was part of his “personalised” NHS speech to the King’s Fund on a day when universities were reported to be braced for severe cuts in staff and funding.
Excellent, agreed Andrew Lansley, health secretary in waiting, but how are we actually going to pay for the extra cancer nurses needed? I didn’t see whether Mr Lansley pointed out that an earlier Brown pledge - free prescriptions for patients with long term conditions - has already been postponed until after the election. He could have done.
Postponed will probably mean cancelled, won’t it? Arrangements have long been in place that allow patients to have a pre-payment certificate, currently for £104 a year - or £2 a week against £7.20 a pop.
A pretty good bargain for all but the poorest (for whom there are other exemption categories), I used it myself until I passed 60 and got mine free. The point is that scrip charges yield around £500m a year to the NHS budget. Not huge, but proper money and it reminds voters (who waste up to 20 per cent of scrips) that the tree-grown theory of money is an illusion.
I mention this familiar story because the PM’s pledge to extend free services is another example - the Brownite personal care at home bill which caused such a fuss in the Lords the other day is another - that strikes me as out of touch with an anxious public mood.
Last week’s HSJ carried an account of NHS managers finalising plans to help reach the £15bn-£20bn which they expect to have to save by 2014 - whoever wins the election. Unions don’t like it, though they are exploring “short time working” (a phrase I normally associate with the car industry) to stave off redundancies.
As with university cuts, that all sounds realistic, more so than Mr Brown conjuring up extra cancer nurses in his parallel universe. But what about the Tories?
As noted here before, they tread a fine line too, tottering between accusations of eagerly gunning for public services and being “too soft”
It has all been made worse by the unexpectedly weak economic growth figures. We thought we could safely take the patient out of intensive care, but find we can’t, explained Cameron when he backtracked.
I was struck by an editorial in The Times, which is currently swinging away from New Labour to the Tories, the old “winning side” strategy of boss Rupert Murdoch.
Condemning an “unhealthy debate”, it complained that Labour’s reforms had improved the NHS, but not enough - and at great expense.
But it regards Tory policy as “even more craven”, its pledge to protect health spending is “a naked and irresponsible political gesture” at a time when pressure must be maintained for higher productivity as costs rise.
I sometimes write that there is a rare degree of core consensus between the main parties on the NHS and mean it as a compliment.
Over hard choices it can also be read as a insult.