Cutting the NHS (1): a new crusade

The queen of leftie hackerie, Polly Toynbee, has me in her debt, after today’s column.

Firstly for reminding me of the faintly sexist allusion of “lipstick on a pig” ( with reference to trying to make the NHS reforms palatable, nothing else).

I do like that Polly Toynbee

Secondly for the following paragraph:

Cash crises breaking out all over. The King’s Fund deputy director says cuts will be closer to £50bn than £20bn. John Appleby reports a 1% cut each year, compounded by 2.5% inflation, when the NHS always hits crisis without at least 2% above inflation to keep up with ageing patients. The NHS Confederation warns of “a super-tanker heading for an iceberg”. There is emergency cash saved by the NHS Commissioning Board this year: Appleby expects mounting trouble from next year to election year. Labour private finance initiatives exacerbate the problem – but PFIs are only 1% of NHS turnover.

Scary stuff from Polly. The difficulty for me is that she and I (who am an NHS stalwart, I suppose), see this financial problem a little differently. Polly’s take is that current NHS spending is all good, and must inevitably rise. Implicit in her analysis is the baffling idea that NHS management are noble, thrifty guardians of the public purse.

My take is that the rising costs of real healthcare (eg the price of antibiotics), could be massively offset by no longer spending money on half the things that have gathered under the umbrella of our national health service.

Believe me, the sort of stuff that you get now, “free at the point of delivery”, is frequently not what Aneurin Bevan had in mind, back in 1948***, regardless of the facts of advances in medical care. I object to a lot of this shit, partly as someone who hands over a colossal amount of tax, but mainly as a working doctor.

I’m not talking about the wisdom of spending a lot of money on chemotherapy that might prolong life by a few months, that’s a different argument. I’m talking about getting the NHS’ nose out of matters that shouldn’t really concern it, or examples of flagrant unjustifiable waste.  So, here’s three suggestions to set the ball rolling. There’s a lot, lot more.

1. There’s no sound clinical reason to have a huge variety of prostheses. 80% or more of all hip replacements, as one example, could be done with a single kind of implant. The price cut, with the NHS purchasing power would be massive, with no clinical detriment at all.

2. The dreaded emotive topic of IVF. If the NHS really has to take this on (The Knife says no), there’s no point each health region funding its own service.  You’re just duplicating costly overheads and diluting expertise. Tell “clients” that they have to cough up a significant chunk of the fee themselves, and get a bulk contract with a private clinic – where the outcomes are often better.

3. NHS Scotland has about 10 health boards, all with their own costly infrastructure and disparate decision making. This is for the same population as one English health region. This is just embarrassing. A single Scottish board would not only avoid duplication, it would get everything cheaper.

4. Sack all psychiatrists

Just joking with that last one. There will be more in future posts.

***For what Labour really feel about the NHS, see Guido here


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