How local government cuts will damage the NHS - Comment is Free, Guardian

26 Oct 2010

Many a politician has built a ministerial career on making otherwise contentious subjects stupendously boring. The concept of a "safe pair of hands" is really built around the idea that as soon as Mr Mogadon opens his mouth, the waiting press corps gently nods off to sleep. The new secretary of state for health, Andrew Lansley, is seemingly hopeful of playing this trick with health. But, unfortunately for him, the government's much vaunted claim that it is protecting the health budget is a hollow sham. And this promises fireworks sooner rather than later.

The underlying problem is that, although the government may be giving the health service roughly the same amount of money, it is making other decisions that will take money away from it.

For instance, the spending review announced a major change to the rules governing underspends across government. This is big money for the NHS. In 2009-9 the Department of Health had specifically told the NHS that it should not spend its full resource allocation in each year. So at the beginning of this financial year it had a cumulative underspend of over £5.5bn. And managers had planned a further underspend of around £1bn in 2010-11. The Nuffield Health Trust claims that, at a stroke of a pen, George Osborne has taken that money away. Andrew Lansley flatly denies this.

Now the acting chief executive of the NHS Confederation, Nigel Edwards, is warning government that the big cuts to local government funding will have a knock-on effect on the NHS. This is because it will incur extra costs when elderly patients have to be kept in hospital, when they no longer need medical care. And this may be because the local support services that they need after discharge have been axed. Local authorities have been given £1m from the NHS budget for social care. But it is not ring-fenced. And local authorities have a knack of sucking up non ring-fenced money into their managerial overheads.

The Tories think that they have insulated themselves from problems over the health service by protecting it from big cuts. But it is impossible to protect things like public health, while slashing public spending across the board. There may be no immediate impact, but the cuts in social housing and housing benefit will inevitably lead to a rise in overcrowding and homelessness with the associated detrimental effects on public health.

Even without these issues, Polly Toynbee has warned on these pages that the NHS has a very tight financial settlement.

There is a gathering storm awaiting this government when the public realises that, despite claims to the contrary, the services that they have come to expect from the health service have in fact been cut.



back ⇢