The evidence against ring-fencing the NHS budget is piling up daily. NHS targets compromise safety in some operations according to a survey. Surgeons are often expected to carry out "complicated operations within tight time-scales" and many were "operating on patients they hadn't seen before". One quote from a surgeon was telling:
"Don't be seduced by management into making do, thinking you are being heroic; you're not, you are being dangerous."
These kind of inefficiencies that are driven by targets also cost money, and such problems will only be compounded as the NHS has a protected budget. No area of public spending should be exempt from savings, particularly the second biggest one. Cuts will have to be far deeper in other departments to honour what was clearly an electoral manoeuvre.
However, the new Health Secretary has actually talked about savings. But the government's commitment means this money would be poured back into the NHS instead of being used to pay down the deficit. Without complete structural reform this would be a waste of time. Why continue with a system where supposedly independent hospitals jump as high as the Strategic Health Authorities, with their central guidelines and targets, tell them too? Reinvesting saved money would mean this kind of restriction would be perpetuated. SHAs cost upward of £4 billion - get rid of them and you save a huge amount of money and allow hospitals to be more independent.
Speaking to a NHS Manager the other day was very informative. He told me that his Trust are inspected by around 60 different bodies. Really, 60 bodies. The work that goes into preparing for these inspections, and ensuring that their spurious targets are met, is apparently astronomical. There are many qualified medical staff that have no patient contact, and haven't done for several years.
Decentralising the system would help. It would mean trusts have the independence to provide for local people; decisions would be taken out of the hands of politicians. European healthcare systems, in Germany, France, Switzerland and the Netherlands, have genuinely independent providers of hospital care and social health insurance that are not managed by politicians. This includes pay bargaining - centralised pay for an organisation operating across the country and with over a million staff is ludicrous. Putting saved money back in to an unreformed NHS would be throwing good money after bad.