The Oil Tanker of NHS Spending Must Be Turned Around

Be still my sinking heart. John Prescott today, via Twitter, challenged David Cameron to a debate on the NHS. The Manchester Evening News published David Cameron's response...

"The real question is why won't Labour match the Conservatives' pledge for year on year real-terms increases in NHS spending over the next Parliament"

David Cameron would have been well advised not to respond to Prescott, who holds no position and is just living up to his nickname of The Mouth of the Humber. But let's ignore Prescott and look at the substance of what Cameron said. I understand the politics of it, but is it really consistent on the one hand to make speeches about how serious our debt crisis is, and then on the other hand tell everyone how NHS spending is ringfenced, and not only that, it will be increased year on year regardless of economic circumstances.?

I do not advocate cuts in frontline services, but neither can I advocate increased spending in a government department which has already been stuffed with money over the last twelve years and failed to achieve the commensurate improvement in service levels.

David Cameron takes a different stance. In his speech today in Bolton he said...

The debt crisis means we need a new approach to public spending, to make sure we get more for less. But in the NHS, even that won’t do. The pressures on healthcare spending – from an ageing population, from medical advances, and from rising expectations – are simply too great... Spending on the NHS cannot stand still, because standing still would be taking a step backwards. That is why we have pledged real-terms increases in NHS spending - unlike Labour – a fact which, to put it mildly, takes the wind out of their point-scoring sails."

So far, so logical. But people understand the need for the government to rein in its horns in times of economic crisis. They understand a party that is honest with people and explains where cuts are going to have to call. What they find more difficult is to trust a party which then says it will increase spending in an area of policy which in the past has been politically toxic for them. To say that the NHS oil tanker of spending cannot be turned around is to give up. It won't be quick and it won't be easy, but it can be done.

We need to cut the levels of absenteeism (which is costing close on £2 billion a year) and increase productivity levels, which have dropped by nearly 5% since 1997. And no one is telling me there isn't waste and bureaucracy which can't be attacked.

If our levels of debt and borrowing are so serious that they threaten the very future of our economy, how can anyone justify ringfencing anything? Just askin'.

UPDATE: Tim Montgomerie has just blogged David Cameron's 12 reasons why NHS spending has to grow. Tim comments...

I readily agree that it is a persuasive list but it would also be possible to draw up similar lists for many other public sector budgets - budgets that have not enjoyed the growth of resources enjoyed by the NHS. My greater objection, however, is the question of affordability. Britain borrowed £8bn last month against an expected borrowing requirement of £500m. The BBC reports that the government's overall debt now stands at £801bn, or 56.8% of GDP, its highest level since at least 1974.

Indeed.