opinion YORKSHIRE TERRIER

Published: 09/05/2002, Volume II2, No. 5804 Page 18

That is all right then: good old Gordon Brown has saved our cherished NHS by promising to inject squillions of therapeutic liquid cash into its sickly bowels.

Excellent for patients who will benefit from the utopian dream made reality - but bad for pundits like me, who make their living from pointing out the flaws and absurdities which until now have abounded in the NHS.

Chancellor Brown has fallen for the oldest trick in the NHS book - that spending more money will solve its ills. Even Aneurin Bevan eventually realised that the NHS is an insatiable beast. Just look at the number of prescriptions dispensed: in 1949 Britons were given around 200 million prescriptions, last year a staggering 600 million.What on earth has happened? Maybe the population has grown by perhaps 20 per cent and there are proportionally more older people around, but even so, surely we are not in such a collectively worse state of health than only a little more than half a century ago?

Of course not. The truth is that the demand for healthcare is literally unlimited. The more money available, the more will be spent, and often to little avail.

The US provides the perfect example of that, with real spending on health more than double that of the UK but little to show for it. OK, waiting lists may not exist, but paradoxically life expectancy is less than in the UK.

Increasing spending on healthcare simply fuels demand for even more of it. The devil makes work for idle hands, and if we have more doctors they think of more things to do with their time, and our bodies - not least writing out more prescriptions.

What would be even worse, from a financial point of view, would be if increased spending did work and millions lived longer lives. Imagine a Britain with twice as many old people and all dependent upon their drugs regimes and regular doctor's visits to keep going. That would be a vicious circle and soak up even more money.

Fortunately for the taxpayer, it will not work out that way. Flinging money at the system will do as much harm as good. The best thing that could happen in the NHS right now is not to increase the money spent, but reduce it.

Squeezing, even slashing, the NHS budget would at last force those in charge to think radically about how to cope, to work smarter and to hack out the dead wood that has accumulated in the 50-odd years since 1948.

There must be billions to spare.

That can be the only explanation why the NHS has been able to afford to spend so much time and energy on reorganisation after reorganisation, why so much manpower and enthusiasm is misdirected into ever more complex bureaucracy or taken up with absurd, clinically dubious or ineffective initiatives such as breast screening, GPs for the homeless and homeopathy.

In an ideal world, people should be too busy to even think about causing chaos with such things as GP fundholding, let alone finding time to introduce a new corporate logo.

It is an excess of cash that allows up to 17 different agencies to be auditing standards in acute hospitals and up to 30 to be involved in monitoring standards in the NHS as a whole.

It is too much money that lets the NHS indulge in such follies as cruelly trying to extend the lives of the terminally ill, medicalising childbirth and infertility, offering terminations on one hand, and on the other, unwisely striving to keep alive ever more hopelessly premature babies.

What we have witnessed over the decades, and especially over the past two, is an ever-increasing emphasis on the peripheral at the expense of the fundamental.

Effort has been concentrated on things that matter little rather than those that are really important.With so many reports and directives rammed down the throats of managers in the past 20 years, no wonder that many feel they are choking on paper.

Less money would help stop that rot. I am looking forward to the day when a trust chief executive, asked why they haven't implemented some new directive from the centre, turns round and says: 'I didn't have time to do both that and help frontline staff deal with patients.' I would sooner pat them on the back that the one who boasts of all the initiatives that have been implemented and blow the fact that it prevented the people who really count from getting on with their jobs.

Four years ago, total NHS spending in England was£39.88bn. This year the cost of the NHS across the UK will be£65.4bn and, if Chancellor Brown has his way, in 2007-08 in real terms it will be£105.6bn - a 100 per cent increase inside a decade. If Derek Wanless has his way the cost will rise to£184bn.

Will anyone be happier, will the NHS be better? Cutting 10p off the price of a packet of fags might achieve the former, but giving the NHS another umpteen squillions will not achieve the latter. l Steve Ainsworth is a former primary care manager.