PM May's NHS cash boost promise prompts Keynesian Guardian editorial

[Peter Dow]

The Guardian view on the NHS cash boost: pay for it with deficit spending

Fri 15 Jun 2018

The public knows that the health service needs more money. Theresa May’s offer is a start – but unlikely to be enough

‘Jeremy Hunt, the health secretary, deserves credit in arguing for extra money. But Mrs May will find the cash because public dissatisfaction with the NHS is at its highest level for a decade.’ Photograph: POOL/Reuters

 

"Finally the penny has dropped in No 10. The prime minister, Theresa May, has recognised that the English health service does not have the resources it requires to provide high-quality patient care, and has told the Treasury to “find the money” the NHS desperately needs. Mrs May seems to be offering to increase the budget of the English NHS by about 3% a year until the end of the parliament, meaning that government spending would rise from around £130bn to £150bn in four years’ time. While welcome, the sums are probably going to be too small to keep pace with the rising cost of drugs and an ageing population that has ever more complex needs.

 

The decision is not an act of compassion. It is not a birthday gift – although it might be sold as such because the NHS is 70 this July. It is not because there is a Brexit dividend – there isn’t. It is because the NHS is falling apart before people’s eyes. GP appointments are harder to come by. Patients routinely sit for hours in overcrowded emergency wards. In hospitals, operations are cancelled more often, because of a lack of beds. Jeremy Hunt, the health secretary, deserves credit in arguing for extra money. But Mrs May will find the cash because public dissatisfaction with the NHS is at its highest level for a decade. Politics demands that she acts.

 

The Tories have no one else to blame for this sorry state of affairs but themselves. Conservative ministers spent the last eight years bleeding the health service dry. Like physicians of old, Tory policymakers believed that bloodletting could heal the sick. It was wrong in medicine. And it’s wrong in economics. It has not just inflicted pain; it has made the patient weaker. Other parts of the system have succumbed: social care offered by local authorities has been decimated by austerity.

 

Mrs May does not want to be remembered as the prime minister who squandered the dramatic improvements that had been achieved by the NHS. Despite the longest budget squeeze in its history, the NHS was last year judged the best and safest healthcare system of 11 developed nations. Unsurprisingly, given austerity, the NHS was reckoned to be cheaper to run than other healthcare services found in comparable economies. What the health service needs is the kind of vision that Tony Blair and Gordon Brown offered almost two decades ago when they decided to raise health spending to the EU average.

 

Before spending more money on the NHS, British politicians should take the advice of the US economist Stephanie Kelton: in a UK lecture this week, she explained that it was wrong for politicians and the media to argue that the government must balance its books, just like a household. If a household were to continually spend more than its income, it would eventually face insolvency; it is thus claimed that the government is in a similar situation. This is false.

 

Yet politicians are obsessed with avoiding an increase in the deficit, an impulse so ingrained that Professor Kelton described as it “almost Pavlovian”. An analysis of the UK’s economic position tells us how to fund the NHS: growth is flatlining, real wages are stagnant and there’s little inflation. The UK’s indebted households are sinking deeper into debt. Hardly the time to raise taxes. The public sector deficit ought to be seen as an instrument to support the economy, not a way to break it. To pay for the NHS, which is critical for long-term prosperity, the government should engage in Keynesian deficit spending: this would help to keep not only the public healthy but the economy too."

 

Without doubt, the UK editorial of the year.

 

Thank you Guardian editorial writer, whoever you are.

 

Might you be interested in editing BBC news and current affairs? If so, you have my vote for what it is worth!

 

Hallelujah! 

A UK newspaper of record finally GOT IT!

 

[Prometheus]

I'm unconvinced an improved NHS is a simple function of funding. The amount of inefficiency and corruption is obscene, and while successive governments have paid lip service to streamlining the service nothing has changed. 

But this is beside the point to how the NHS should be funded in lean years. Is it too simple to rely on the wisdom that you save during the abundant years to see you through the lean years? 

 

[Ten oz]

24 minutes ago, Prometheus said:

I'm unconvinced an improved NHS is a simple function of funding. The amount of inefficiency and corruption is obscene, and while successive governments have paid lip service to streamlining the service nothing has changed. 

But this is beside the point to how the NHS should be funded in lean years. Is it too simple to rely on the wisdom that you save during the abundant years to see you through the lean years? 

 

In western democracies it seems there is always enough money for industry welfare and or economic stimulus be it through tax credits or loans but never enough money for social services. I see this as being cause by 2 different factors. The first being that the standard western business model demands continues growth which isn't a worker-able model for something like Healthcare. Many of the administrators with an accounting, business, human resource, and etc education/background are trained for pro -growth environments which are not applicable and as a result many are incompetent at their jobs. It simply doesn't work to run a service meant to provided care to people like a shareholder owned for profit business. The second problem is the general public's tendency to think in a punitive manner. When the public dislikes any portion of something the tendency is often to vote against the whole receiving govt funds regardless of the downstream effects rather than supporting improvements. Rather than productive change through careful consideration change is punitively forced by the removal of funds.

 

[Phi for All]

5 hours ago, Prometheus said:

The amount of inefficiency and corruption is obscene,

Is there an obvious source to either of these? Is the inefficiency a product of publicly-funded programs? In the US, when it comes to public funding, corruption seems most likely to happen where those programs interact with privately-funded concerns. How does your healthcare corruption manifest itself?

[Scott of the Antares]

5 hours ago, Ten oz said:

It simply doesn't work to run a service meant to provided care to people like a shareholder owned for profit business.

 

This. Exactly this. PFIs and villainous marking up of sundries should be outlawed as a first step.

Healthcare is most important (I think), but I think Ten Oz’s words apply just as well to the UKs water supply, electricity supply and train network. Selling off vital services is never of the users interest; if it can’t be ran well by under public ownership than it shouldn’t be viable as a profitable investment for a private company.

[StringJunky]

6 hours ago, Prometheus said:

I'm unconvinced an improved NHS is a simple function of funding. The amount of inefficiency and corruption is obscene, and while successive governments have paid lip service to streamlining the service nothing has changed. 

But this is beside the point to how the NHS should be funded in lean years. Is it too simple to rely on the wisdom that you save during the abundant years to see you through the lean years? 

 

But how can you save when you are perpetually poor? The model needs to be  that NI should rise and fall with the needs of the NHS. Healthcare is expensive. We've only got to look across the pond to see the alternative.

[Prometheus]

57 minutes ago, StringJunky said:

But how can you save when you are perpetually poor? The model needs to be  that NI should rise and fall with the needs of the NHS. Healthcare is expensive. We've only got to look across the pond to see the alternative.

I'm not advocating private healthcare. I'm just saying putting more money in won't necessarily improve services. I was lucky enough to start my nurse training when Labour started pumping money into the NHS but I saw a hell of a lot of waste. £20 billion extra per annum is a lot of money; it is reasonable to ask that the NHS spends it well. Currently it does not.

Edited June 19, 2018 by Prometheus

[John Cuthber]

8 hours ago, Prometheus said:

The amount of inefficiency and corruption is obscene,

The cost is roughly in line with other similar systems (and about half the cost of the US healthcare system)

[Scott of the Antares]

1 hour ago, John Cuthber said:

The cost is roughly in line with other similar systems (and about half the cost of the US healthcare system)

But the wastage; several years ago the government scrapped a computer system to hold the NHS patient records. The cost of this folly? 10 billion GBP.

The profit made by companies building and running hospitals for the NHS? 830 million GBP. That 830 mil of taxpayers moneys that should have been spent on healthcare, not private profits.

NHS PFI debts? 2 billion GBP per year.

How much does a ball point pen cost? Pence? The NHS pays several times the value for some reason on lots of sundries.

 

[John Cuthber]

Right wing govt  policy has forced the NHS to disband much of its own IT provision and to buy services in from outside.

The claim is that "private sector work is more efficient".

But in fact it means the the NHS gets IT provision from companies with the same business model as Carilion.

The long standing joke is that PFI means "profits for industry"; it's just a mechanism for moving taxpayer money to big companies.

[Prometheus]

2 hours ago, John Cuthber said:

Right wing govt  policy has forced the NHS to disband much of its own IT provision and to buy services in from outside.

But in fact it means the the NHS gets IT provision from companies with the same business model as Carilion.

The long standing joke is that PFI means "profits for industry"; it's just a mechanism for moving taxpayer money to big companies.

I don't dispute any of this, but it does not mean NHS should continue to be wasteful.

 

2 hours ago, John Cuthber said:

The claim is that "private sector work is more efficient".

No one has made that claim here, a.k.a. strawman.

[DrP]

16 minutes ago, Prometheus said:

I don't dispute any of this, but it does not mean NHS should continue to be wasteful.

 

David Careron's lot promised cut backs to red tape, middle management and wastage in the NHS. What happened there? That was about a decade ago.

I don't see why we don't have an efficient well working NHS...   I suppose in some ways we still do (if you look at the size of it and how many people it treats it is an amazing service). If we could properly stamp out the wastage and the corruption then it would be an amazing service still. I don't think some want it to work because they can make more money from private sector health services than from the NHS.  

2 hours ago, John Cuthber said:

The claim is that "private sector work is more efficient".

It will be if you cripple the public service with poverty. As I said - some want to see it struggle so they can claim it is unworkable so they can make their own money from their shares in private companies - probably.  

[Prometheus]

3 minutes ago, DrP said:

David Careron's lot promised cut backs to red tape, middle management and wastage in the NHS. What happened there?

Not just that government, successive governments have paid lip service to the idea. The conservatives use it to privatise bits and pieces and labour use it to strengthen labour laws such that its near impossible to sack dangerously incompetent health professionals.

 

5 minutes ago, DrP said:

I don't see why we don't have an efficient well working NHS...

If people are willing to put that money in, that's fine. It can be a frustrating environment to work in though - lazy people can hide in the background, innovation is stifled, terrible nurse training and bad retention rates. I just find it strange that in many public debates if someone points these things out they get pilloried for hating the NHS. Why accept the status quo - why not try to improve efficiency? Why can't this be done without privatisation?

 

11 minutes ago, DrP said:

I don't think some want it to work because they can make more money from private sector health services than from the NHS.

I suspect there are some people doing extremely well out of the NHS.

[DrP]

23 minutes ago, Prometheus said:

I suspect there are some people doing extremely well out of the NHS.

And so they should....  but properly and without abusing it.

 

There is so much waste it is untrue.  That Jeremy Vine BBC short film a few years back about the wastage of BILLIONS in the NHS under Blair/Brown was heart breaking...  it was a good idea to inject billions into the NHS at the time....  but it was a bad idea to let incompetent prats decide how it was to be spent.   They revamped ONE hospital to the tune of millions and made it great. Everything they spent was tailored to that one hospital - great. They then rolled out the EXACT same purchase package for every other hospital - regardless if that hospital had already been revamped, regardless of whether that hospital actually needed the kit that was in the package they got it all any way at the tune of billions of pounds being spent on unwanted and unneeded kit. It was devastating - there were hospitals waiting for kit they had requested for years being delivered with totally irrelevant kit that they did not need. Total waste and the majority of places did not receive what they actually wanted and needed  -  they all got the same. Total incompetence and waste of Billions.     They should have asked the individual hospital managers what each hospital needed.

They had hospitals that did not deal with oncology being given expensive machines that they did not need and hospitals that had already been kitted out with the top end kit being given stuff they already had. I can't believe it could possibly have been through incompetence - no one can get a job THAT high up and be so incompetent surely - I can only assume they made a pretty billion or 2 out of selling large amounts of unwanted medical kit to the public, passing it off as a cash injection to the NHS  - it wasn't - it was a cash injection to the companies that make medical equipment.   As Vine said in his documentary, with tears in his eyes, 'The level of incompetence with how our money was spent would be highly laughable.... except we could have done SO much more with that in the NHS if each hospital had the same tailored expenditure as the first one'.

 

[Prometheus]

37 minutes ago, DrP said:

no one can get a job THAT high up and be so incompetent surely

I think there are two levels to this.

There's just some outright corruption - except it's legal, so technically not corruption.  I worked for one trust which bought equipment at stupid prices (as ever) from a company belonging to the wife of the trust's CEO. It was reported in the Private Eye but i never saw the story in mainstream media.

Then there's outright incompetence. There are some extremely bad middle managers - but they can't be sacked. So once they get identified as being bad, they are just moved around departments, spreading the damage around instead of concentrating it. Ideally they are moved to another trust, helped by giving them a glowing reference. And so they climb. It also helps if they bully staff - far quicker promotions. 

I think the former group depends on the latter group.

 

49 minutes ago, DrP said:

And so they should.... 

I was on £35k when i left A&E, which i think was reasonable, but too much for my next destination as a research nurse. Many nurses get paid too much because they don't do any work, hiding behind nurses actually doing their work plus the slack but getting the same pay. I also think GPs get paid way too much, while some hospital doctors don't get nearly enough (med reg). But it's a one size fits all type system.

[Phi for All]

Publicly-funded programs should never cater to private wishes for investment opportunity. That's not what those funds are for. 

All the tricks your "conservatives" are using are SOP in the US. Hobble the program, step on its throat, and make fun of how it can't stand on its own. It starts small and gets much worse. 

Our public Postal Service could put UPS and FedEx out of business in short order if they were allowed to do what any businessperson would do in their place. If they were allowed to buy their own planes instead of being forced to outsource to private carriers, the private carriers couldn't compete because they need too much profit. If the Postal Service were allowed to do money orders (since post offices are everywhere), companies like Western Union would be obsolete. Our public services often face far more regulation than what the private sector keeps crying about. Everywhere the Postal Service could use their vast reach effectively is being stomped on, and there are calls every day to privatize them. 

[DrP]

1 hour ago, Phi for All said:

All the tricks your "conservatives" are using are SOP in the US.

Although the thing with the NHS I pointed out was under a Labour government. So too was Gordon Brown's selling off our gold at record low prices (presumably to his mates or with a massive kick back) just before they quintupled in price.   

It was hailed as a success - it was a success for 1 hospital (probably a few others too being fair). What they should have done was just given the budget directly to the hospitals or at least asked them for a wish list.  I do not believe they did not know this was a totally stupid idea and a waste of billions. I bet many retired or have amazing retirement nest eggs for their extended families from it. C###s.  

 

[Phi for All]

5 hours ago, Prometheus said:

I think there are two levels to this.

There's just some outright corruption - except it's legal, so technically not corruption.  I worked for one trust which bought equipment at stupid prices (as ever) from a company belonging to the wife of the trust's CEO. It was reported in the Private Eye but i never saw the story in mainstream media.

Then there's outright incompetence. There are some extremely bad middle managers - but they can't be sacked. So once they get identified as being bad, they are just moved around departments, spreading the damage around instead of concentrating it. Ideally they are moved to another trust, helped by giving them a glowing reference. And so they climb. It also helps if they bully staff - far quicker promotions. 

I think the former group depends on the latter group.

It's plain to see the way profit-as-the-priority corrupts public trusts that need to focus on how they benefit society. I think it's been responsible for many major decisions that might have been different without the private agenda.

It probably deserves its own thread, but I'm curious how healthcare professionals view the single-use disposable strategy wrt medical paraphernalia. Is it really better/safer for the patient? Is it a time saver for the doctors and nurses, or do they spend just as much time on discarding everything after using it once? I've had first-hand experience with companies that sell machines that filter blood, and their entire business strategy is just like Nintendo: sell the expensive machines at cost (or below) and make your profit on the disposable bags and filters and whatnot (which are usually marked up hideously high). Is it this way with the NHS? Even tools like forceps aren't sterilized any more, they're used once and thrown away. Maybe it's just me, but I think the line between infection safety and cost effectiveness is slowly being erased rather than considered. 

30 minutes ago, DrP said:

Although the thing with the NHS I pointed out was under a Labour government. So too was Gordon Brown's selling off our gold at record low prices (presumably to his mates or with a massive kick back) just before they quintupled in price.   

It was hailed as a success - it was a success for 1 hospital (probably a few others too being fair). What they should have done was just given the budget directly to the hospitals or at least asked them for a wish list.  I do not believe they did not know this was a totally stupid idea and a waste of billions. I bet many retired or have amazing retirement nest eggs for their extended families from it. C###s.  

Is your government like ours, where when the Republicans are in power, they staff certain agencies they don't like with people they know will run it into the ground and make it look bad (*cough* EPA *cough*)? I can't think of an equivalent for Democrats. They may call for less military spending (just like Eisenhower, Nixon, and HW Bush did), but they don't put an idiot in as Secretary of Defense and have him destroy the effectiveness of our armed forces. 

[Prometheus]

18 hours ago, Phi for All said:

It probably deserves its own thread, but I'm curious how healthcare professionals view the single-use disposable strategy wrt medical paraphernalia.

On the frontline the price of just about anything just doesn't enter your mind. When i first started training some bits and pieces from wards were still re-used, like the scissors and forceps from suture packs but they would so often get erroneously thrown into clinical waste bins or sharps bins someone made the decision that it was just easier and cheaper to throw it all away. Although such times aren't too common, when you've got a patient swimming in shit and another in sepsis needing antibiotics you don't want to be spending any time separating out waste.

I doubt that a cost/benefit analysis has been performed - a quick google revealed only companies advocating it.

Actually Google scholar had this, i don't have time to read more than the abstract though.

[Phi for All]

3 hours ago, Prometheus said:

On the frontline the price of just about anything just doesn't enter your mind. When i first started training some bits and pieces from wards were still re-used, like the scissors and forceps from suture packs but they would so often get erroneously thrown into clinical waste bins or sharps bins someone made the decision that it was just easier and cheaper to throw it all away. Although such times aren't too common, when you've got a patient swimming in shit and another in sepsis needing antibiotics you don't want to be spending any time separating out waste.

I doubt that a cost/benefit analysis has been performed - a quick google revealed only companies advocating it.

Actually Google scholar had this, i don't have time to read more than the abstract though.

I think once an institution adopts the disposables concept, it's difficult to accurately gauge whether they're better off without it. Certainly there are situations where the concept is tailor-made and highly successful. Equally clearly, once companies begin manufacturing sensible disposables, it becomes easier to accept those products that aren't so sensible, but follow the concept. I brought it up because I wondered if rising costs in the NHS weren't partially because more and more equipment is being converted to use disposable technology. 

[StringJunky]

3 hours ago, Phi for All said:

I think once an institution adopts the disposables concept, it's difficult to accurately gauge whether they're better off without it. Certainly there are situations where the concept is tailor-made and highly successful. Equally clearly, once companies begin manufacturing sensible disposables, it becomes easier to accept those products that aren't so sensible, but follow the concept. I brought it up because I wondered if rising costs in the NHS weren't partially because more and more equipment is being converted to use disposable technology. 

It's probably worthwhile if it improves clinical outcomes by reducing the possibility of contamination. Adverse patient events due to this may actually cost more economically to mitigate, besides the human cost.

Edited June 21, 2018 by StringJunky

[Phi for All]

6 minutes ago, StringJunky said:

It's probably worthwhile

Probably. It seems perfect for some situations.

But it's also a profit-maximization strategy I dislike and distrust in other sectors. When you care more about the convenience of using the product than what it's actually supposed to do for you, and ignore how much trash you're generating for the landfills, you end up with Keurig coffee. 

[John Cuthber]

On 6/20/2018 at 9:09 AM, Prometheus said:

No one has made that claim here, a.k.a. strawman.

Nobody had claimed that anyone had made that claim here.
It is a claim made by Right wing governments.

 

So your "strawman" call is... well...erm... a strawman.

On 6/20/2018 at 9:55 AM, Prometheus said:

labour use it to strengthen labour laws such that its near impossible to sack dangerously incompetent health professionals.

Could you show us examples of those laws please?

On 6/20/2018 at 9:35 AM, DrP said:

f we could properly stamp out the wastage and the corruption

I haven't seen much evidence of corruption in the NHS (the pharmaceutical industry is another matter).
Waste is almost inevitable in any large organisation. but it may be outweighed by economies of scale.

The cost of sterilising a pair of forceps is irrelevant if you have a doctor being paid £100 an hour kept waiting because the autoclave hasn't cooled yet.
Disposables are cheap (but environmentally unfriendly)

[Phi for All]

43 minutes ago, John Cuthber said:

Disposables are cheap (but environmentally unfriendly)

"Cheap" is the part I'm unsure of, based on my experience in other sectors. Is there a product that isn't more expensive in the long run when the original high-quality unit is made disposable after a single use? But as you pointed out, there may be other factors (such as time mismanagement that causes a doctor to be kept waiting while his tools cool) that play a part in the decision. I hope it's those factors, and not simply an overshadowing profit motive from medical equipment manufacturers (who have many of the same motivations as big pharma). 

If May were POTUS, I'd suspect she was doing this to profit some private vendors while making it look like she was helping healthcare. We also get lots of conservatives these days who used to want a balanced budget, until it was their turn at the helm. Now they all sound like the US economist quoted in the OP.

[CharonY]

3 minutes ago, Phi for All said:

Cheap" is the part I'm unsure of, based on my experience in other sectors. Is there a product that isn't more expensive in the long run when the original high-quality unit is made disposable after a single use? But as you pointed out, there may be other factors (such as time mismanagement that causes a doctor to be kept waiting while his tools cool) that play a part in the decision. I hope it's those factors, and not simply an overshadowing profit motive from medical equipment manufacturers (who have many of the same motivations as big pharma).

Ultimately, what sells are things that maximize convenience and minimize errors, as the latter can skyrocket costs in the medical field. While there have been pushes toward reducing carbon footprint, the increasing danger of resistant infections have pushed some to go the "better safe than sorry" route.