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Whichever party spouts it, talk of the NHS budget being ring-fenced is a complete fallacy

Every reform leads to upheaval, and upheaval costs money to sort out

Armando Iannucci
Thursday 23 April 2015 17:42 BST
David Cameron talks to staff during a visit to the Salford Royal Hospital accident and emergency department
David Cameron talks to staff during a visit to the Salford Royal Hospital accident and emergency department (WPA Pool/Getty Images)

How the parties talk about the NHS this election helps illustrate both the perils and possibilities of the new politics that may emerge on the morning of 8 May. It would be easy to assume the NHS is safe in everybody’s hands at the moment.

Labour, Lib Dems and Conservatives have gone out of their way to stress how ring-fenced and positively smothered in a 50ft-thick concrete casing of love the NHS is this time round. But it’s difficult to believe the actual details of how they’ll find the money for their commitments while carrying on with their defecit reduction plans elsewhere.

The problem is, ring-fencing a budget doesn’t work when the institution you’re claiming to protect is so infuenced by every other sector in government: these other departments are less protected and will face deep cuts, and inevitably the NHS will be affected.

So, for the past five years, our health service has faced increased pressure from cuts in social care, mobility benefits and local social welfare monitoring of troubled families, financial hardship and mental health. A rise in food bank use has also seen a rise in depression; and if people are hungry, they’re probably more ill. Suicide rates have increased among those with benefit sanctions and cuts to mobility allowance. And what does it do to an elderly couple when they’re told they must either pay tax on their spare bedroom or move?

It’s a fallacy to say that an NHS budget can be ring-fenced: it can’t, any more than you can ring-fence your health from your life. The main parties have backed themselves into this argument, though; they’ve done so because all three have participated in top-down reforms and bizarre obsessions with private business models that have perplexed the medical profession and angered a public who at no time have had any say in whether they wanted them or not.

No minister has got up in public and proclaimed the virtues of the Private Finance Initiative, no party has won support on the back of putting things out to private tender, and, most ignominiously of all, no party mentioned in the 2010 election the massive and confused restructuring that was the recent Health and Social Care Act. Add to that the number of former health ministers who now sit on the board of private healthcare companies, and you can see why this recent past is quietly shielded from discussion.

This time though, many members of the medical profession have become so frustrated with the standard of argument that together – doctors, nurses, paramedics, midwives, healthcare workers – they’ve formed their own party, the National Health Action Party, or NHA, fielding candidates in 12 constituencies.

Time for full disclosure here: all three of my children were born at the Silver Star specialist baby unit in Oxford’s John Radcliffe hospital and I’ve been patron of the unit’s fundraising charity, so I know something of the issues affecting the campaign of the NHA’s candidate in Oxford West and Abingdon, Dr Helen Salisbury. Talking to them, though, I get a sense of a group of supporters and health professionals, many of whom have never been a member of a political party, feeling so angered and frustrated with the way things are going with the NHS that they feel they must stand up and be counted.

'Where's the fence, and do you have the ring?' David Cameron and Nick Clegg on a visit to Guy's Hospital
'Where's the fence, and do you have the ring?' David Cameron and Nick Clegg on a visit to Guy's Hospital (Getty Images)

They describe to me a service where 10 per cent of GP surgeries are now run by for-profit companies, and what that privatisation does to the bond of trust between a GP and his or her patient (does a patient feel they’re recommended medication because the surgery has a deal with a drug company, for instance?).

They point out to me how significant the recent Health and Social Care Act was in that it removed for the first time the Health Secretary’s legal duty to provide key health services across the country. They show me how transaction costs for delivery of healthcare have gone up from 4 per cent to 14 per cent in recent years, because every reform leads to upheaval, and upheaval costs money to sort out. They draw my attention to a culture of targets on waiting lists and call-out times that has led to, among other things, paramedics getting urinary tract infections because, in the drive for efficiency, they’re being refused bathroom breaks.

Parties like the NHA start with a disadvantage in the first-past-the-post system, and voters will have to work out for themselves whether they take votes away from larger parties who stand a better chance of toppling the status quo. But it’s surely healthy that in this election smaller parties and more specialised campaigns are being heard and could possibly wield influence if one or two of their candidates were elected?

Single-party governments disperse about 150 ministerial posts to their members, locking them into a tribal loyalty that will not question or scrutinise the line from No 10 or the Treasury. If Parliament returns even a handful of MPs from outside that system – people who can bring passion for and direct experience of the issues – then this will be a good election.

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