Fix the public finances before promising to spend more taxpayers’ money

Norman Lamb MP – the Liberal Democrat Minister for Care and Older People – gave a very interesting speech at the party’s Conference in Glasgow earlier. Ostensibly a speech about the NHS, Lamb made a few points which are worth picking up on that suggest the TPA’s campaigning on the deficit, and public debt, are getting through to politicians.

Talking about the NHS, Lamb said:

The central threat to the NHS is the state of the public finances

He’s not wrong. Regardless of what anybody thinks about the NHS and its current model, the performance of certain hospitals, and whether there are other contributory options which might deliver better outcomes, it is disingenuous to suggest that the health of the public finances is somehow divorced from policy-making.

Lamb noted something  else about the deficit, public debt, and the result it has on public services.

Yet as our national debt grows year by year as we borrow to keep public services going, so the amount we spend on interest to service that debt grows. £52 billion pounds this year alone in interest on debt.

“Every pound we spend on interest on debt means a pound not spent to support someone with dementia, to provide therapy for someone with severe mental ill health or to ensure that a cancer patients gets access to drugs that can keep them alive.

Lamb is right. When taxpayers’ money is spent servicing debt, it has no impact whatsoever on the quality of the public services we receive. All decisions on public services made by any politician must be made through the prism of paying down that credit card bill. Many who campaign for even more spending pretend that things like the NHS or the foreign aid budget are somehow separate from the wider economic conversation. They can’t be allowed to get away with that dishonesty. The Treasury’s coffers are inextricably linked to the services we can afford.

Now, the Minister’s speech wasn’t perfect, with the obligatory giveaways – easy with other people’s money. But it did make a number of other points – particularly around the cost of our outdated way of dealing with mental health issues – that should be heard. Not least, his reminder that the way we fund our health service currently confuses inputs and outputs.

Let’s end the rewards to hospitals for just doing more and instead reward patient safety, compassionate care, and achieving the best outcomes.

This should be the mantra for all politicians’ spending decisions. One – should we be doing this at all? Two – if so, can we afford it? Three- if we can, how can we deliver the best outcomes? More of that in the NHS, and the rest of the public sector, would be a step in the right direction.