Today's health debate

Money-tree1 The health spokesmen for the three major parties today debated their positions on the Daily Politics. It was like a microcosm of the entire campaign: lots of promises with very little detail of how to pay for them. The closest anyone came was Lib Dem Norman Lamb, who said that a cap on pay rises to £400 in the NHS would be used to help pay down the deficit. A start, but not exactly a barnstormer. And even this was said in the sheepish tone of someone who did not want to be seen to be advocating taking money out of the NHS.

Indeed, he was roundly lambasted by Andy Burnham of Labour and Andrew Lansley of the Conservatives, who are both committed to spending pledges of one kind or another. But in truth, this resonates with what we have been saying for months, and what the IFS said yesterday: the parties are simply not being honest enough about how they plan to deal with the harsh reality of the fiscal crisis. Every spokesman today mentioned efficiencies and getting more for less - failing to mention precisely how they could do this. This is no surprise; at the TPA's post budget briefing, William Norton showed that the biggest efficiency savings in the Operational Efficiencies Programme had to occur in health. But what he also showed is that the majority of the efficiency savings are as yet unspecified.

Discussed was the big growth in non-frontline staff in the last 10 years. The politicians on TV today talked about the increase in NHS managers, whose numbers have increased by 84 percent since 1999. True - and this had added layers of bureaucracy. But what no-one mentioned was the big increase in other non-medical staff: over 28 percent in the same period. A TPA video showed that the Union's scare tactics about cuts to frontline jobs actually hide a swathe of non-frontline jobs that could be cut.

In a debate that at times descended into an unedifying squabble - inaudible with 3 voices shouting over one another - broader public health issues were discussed. The parties disagreed on extended licensing laws and on minimum pricing for alcohol. Important stuff no doubt, but today's debate was heavy on electioneering and light on detail.

The truth is that the NHS suffers from the same ills as many other public bodies: an over reliance on inputs (i.e. increasing funding) to achieve basic outputs (targets) means that the quality of care suffers (productivity). What's needed from all parties is a long-term plan, with named, costed savings and specified efficiencies to help cure these ills. Dealing with health, like the deficit, requires detail and honesty. Without this the NHS will remain sclerotic.

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