Though Cowards Flinch

So Cameron’s banging on about ring-fencing NHS spend but still slashing the deficit.  There’s even 1,000 big posters gone up to say so.  Giles at Freethinking Economist thinks they make an impossible promise.

Nah, course not. 

Increasing NHS spend signficantly while actually spending less money is a piece of piss, if you know how to go about it.  Both parties know that.  It’s just that Cameron’s team look like they may be better at cheating.

Here’s how you do it.

1.  Admit, as the health secretary did in December when pressed by the Health Service Journal, that funding for most or all adult social care will be transferred from local authorities to Primary Care Trusts (PCTs) in the NHS, but keep it quite quiet in the official documentation, referring only obliquely to a 

‘need to reform adult social care services, improve integration with health and make services more preventative in nature, while delivering a funding model that is fair and affordable for the state and for individuals’ (para. 2.83).

2.  This allows you to transfer funding straight from democratically elected local authorities to the PCT quangos.  This funding is pretty big money.  For example, in Lancashire the Adult Social Care budget takes up 23% (£415 million) of the overall revenue budget of the £1.78 billion.  If all this is transferred it will add £415 million to a total PCT budget for the County area of roughly £1.9 billion (based on a quick look at last year’s annual reports for the three PCTs covering the area). 

3. So, if you were to transfer all the money over, heh presto, you’ve just added a whacking 22% to the NHS budgets (most money for hospitals is channelled through PCTs via their commissioning arm).  That’s something to stick up on a big poster.

4.  But of course you don’t have to transfer it all over.   Swipe 30% off it and you’re still adding to the NHS budget by about 15%, and you don’t have to tell anyone that it’s not really additional money at all, and that what in fact you’re doing is making massive cuts.  

5. You also get to make massive cuts to council budgets like you said had to be done, because everyone knows that councils are totally wasteful, run as they are by crappy, corrupt councillors,  and none of their spending is important enough to ring-fence.  After all, who actually knows that nearly a quarter of budgets goes on what is effectively a part of the overall health and social care service?

6.   With all this ‘additional’ NHS spend, no-one will notice all the additional millions being spent on consultants called in to advise on the process of organisational restructuring that will be necessary to transfer some of the money from one bank account to another, in a way which only allows for the quiet making of cuts which directly impact upon the lives of some of the most vulnerable people in the country.

Yeah.  Protecting the NHS while bringing down the deficit is a piece of piss.  Both parties know that, but the Tories worked it through first.  No wonder they’re so keen to talk about the NHS now.