GEORGE ORWELL once wrote, “Those in power control the future, by controlling the past”. In a rather unorthodox twist, Gordon Brown has adopted an almost opposite position. His technique, both as Chancellor of the Exchequer and now, as Prime Minister, has been in colonising the future rather than the past in order to hold sway over the present.
Influentially, the most forward looking of the inquiries that he commissioned at the Treasury was a 20-year vision of the money needed in turning the publicly financed NHS into “a really good health service”. A report issued by Derek Wanless, a former banker, recommended, in the first-instance, a significant 5-year boost in its funding and resources. In 2002, when Mr. Brown was at the Treasury, the proposals were approved, effectively sanctioning annual increments in the NHS budget of 10%. In real terms, after deducting inflationary pressures, this is worth around 7% growth, guaranteed as it was until the end of the last financial year 2007-08.
An examination of how that money has been spent and, specifically, what it has achieved, might seem a palpable starting point before any new policies are considered. Did that happen? Brown’s preponderance and one of his first decisions since becoming Prime Minister was in asking Lord Darzai (a junior health minister) in formulating the way ahead over the next decade for the NHS. And, yet, awkwardly, the ‘Kings Fund’ (a health policy think-tank) came up with the bright idea by commissioning Sir Derek in taking another look at the time. That examination casted back, rather than forward makes uncomfortable reading for the Prime Minister.
It is likely that only diehard opponents of the NHS would dispute advances made in recent years. But, genuine advances have been very real such as those patients needing operations, like cataract removals, who no longer have to wait as long as before, before being operated on. Many more doctors and nurses do now work in the NHS, compared to the situation that Labour inherited in 1997; hospitals have been empowered in purchasing and procuring expensive and innovative technologies such as MRI scanners. GP’s appear to be prescribing more cholesterol-lowering statins that significantly reduces the risk of heart attacks and strokes.
Rationally speaking, though, given such vast sums of money the NHS has received, it would have been rather extraordinary if the NHS had not got better. The question, now, is whether it has improved enough given the amount of resources and funding it has received? Sir Derek’s report highlights that the British taxpayer has received a return that is, ‘poor value for money’.
The risk of throwing unlimited sums of money into the NHS was that much of it would be soaked-up in higher costs rather than producing more and better health care. In retrospect, this is exactly what did happen. For instance, Sir Derek’s report finds that 43% of the extra funding given to the NHS since 2002 has gone directly in paying higher pay and prices. New contracts for doctors and a healthy boost in earnings for nursing and other NHS staff accounts for 90% of these higher costs.
One of the main objectives of the new contracts was in raising productivity. Sir Derek finds scant evidence of any such payoff. Rising unit costs betray a failure in making the efficiency gains, first envisaged, when the plans were originally set-out in a desire to regenerate the NHS.
Underpinning much of how the NHS has been regenerated is focussed around smarter use of information technology which, in essence, could and should help raise productivity as well as making patient-care safer. The government’s push in a yearning to introduce electronic patient records, though, has clearly been dogged with delays and setbacks. Indeed, on a 10-year projection to 2013 expected to cost £12.4 billion, MPs on the health committee of the House of Commons collectively highlighted, “a worrying lack of progress on implementing local systems”.
Since the start of this financial year, from April 2008, the real annual growth in NHS funding is expected to halve. The financial clamp-down, much needed after such vast sums having been poured into the NHS in recent years, should not really amount to a hindrance. The lessons of the past 5-years are that money alone cannot cure the ills of the NHS.
© Mark Dowe 2008: all rights protected
References:
- Guardian Editorial, 01 July 2008: “A promising prescription”
http://www.guardian.co.uk/commentisfree/2008/jul/01/nhs.health?commentpage=1&commentposted=1
- Allyson Pollock: “Farewell to a free NHS”
… Read the small print: Lord Darzi’s report paves the way for Labour to charge for NHS care.
http://www.guardian.co.uk/commentisfree/2008/jul/01/nhs.health1
