With the re-announcement of money for the NHS, the health service faces a very real risk of raised expectations and a budget increase too low to deliver on them. By Andy Cowper
The government is re-announcing the same pot of money for the NHS?
Mmmmmm. If not mmmmmmmmmmm.
It’s just like déjà vu, all over again.
Several things about this are strange, including the sub-heading ‘New funding for primary and community healthcare by 2023-4 under the NHS Long Term Plan’. It’s delightful that for once, the government got the year right in which the announced new money will at last be fully on stream, but the NHS Long Term Plan – the 10-Year Forward View, if you will – isn’t even finished yet.
And there can be no possible doubt that our dearly beloved friends, the Treasury Munchkins, will have to sign the 10-Year Forward View off, once the draft is finished.
The press release goes on to assert that “The prime minister set out a major new investment in primary and community healthcare – worth £3.5 billion a year in real terms by 2023-4 – which builds on the existing NHS budget for these services.
“This represents a historic commitment to ensure a growing share of overall NHS spending for primary medical and community healthcare”.
I don’t want to have to swear in this column. I honestly don’t. But this is incitement, pure and simple. OK. Deep breath. And another.
OK, this statement is extremely tangential to the truth. As the health thinktanks were mercifully quick to fact-check.
As Nuffield Trust senior policy analyst Sally Gainsbury observed, “this additional money amounts to annual increases that are broadly in line with the 3.4 per cent overall that the NHS in England is getting over the next five years … far from representing a big shift in funding towards out-of-hospital services, this money will simply allow GPs and community services to keep up with demand over the next five years”.
Re-announcing new money: really not new
So what is going on here – fund it once, announce it multiply – is nothing new at all, politically speaking.
It is clear that the effect of leaving the EU on the British economy will be negative
Readers who remember the New Labour funding boost of the early 2000s may nostalgically recall how the then-Chancellor Gordon Brown was something of an artist in re-announcing new money for public services. We might as well call this move “Brownian Motion”.
It is as nothing when compared to the breathtaking mendacity of the prime minister’s “letter to the nation” trying to sell her Brexit deal, which claims, “We will take back control of the money, but putting an end to the vast annual payments to the EU. Instead we will be able to be able to spend British taxpayers’ money on our own priorities, like the extra £394 million per week that we are investing in our long-term plan for the NHS”.
Mrs May is foolish in allying her deal to the Vote Leave NHS bus pledge in this way: the false equivalence of which between lower/no EU contributions and higher NHS funding is now as discredited as the original claim was eye-catching.
It is clear that the effect of leaving the EU on the British economy will be negative. The only debate among serious economists (ie those whose surname is not Minford) is by how much the public finances will be worse off post-Brexit.
Johnsonian home economics
As regards public spending, it increasingly feels as if the government cannot count correctly or does not want to. This is not reassuring.
It feels more as if the guiding principle as are those of buffoon and former foreign secretary Boris Johnson. Mr Johnson has been sacked from most jobs he has held for lying. Add to this his repeated mantra that he is ‘pro having our cake and pro eating it’, and we have a whole new science: that of Johnsonian home economics.
Home economics and health economics are two distinct disciplines, but in neither world is the concept of the opportunity cost invalid. If you eat your cake, you no longer have it: that is the opportunity cost.
Brownian motion is the political equivalent of attempting to eat the cake and have it. You simply recycle the announcement of new money, and you hope that experts don’t notice.
But experts do notice. And if you look at the latest edition of the long-running Ipsos MORI veracity index, you see a hierarchy from experts (teachers, engineers and professors) and clinicians (nurses and doctors) being the most trusted; civil servants, pollsters and charity chief executives in the middle of the pack; and ministers and politicians and advertising people at the bottom – yes, just below journalists.
As I wrote recently for the British Medical Journal, the NHS faces a very real risk of raised expectations and a budget increase too low to deliver on them. I will return to this theme soon.