Bill of health
Extra cash for the NHS must come with conditions
MAX PEMBERTON
I
t would be daft for someone to offer
you £1.8 billion and you turn it down.
That sort of money isn’t to be sniffed at.
This is how much Boris Johnson announced
he would give to the NHS as an extra funding
boost. And I don’t want to seem churlish or
ungrateful — after all, those of us who work
in the health service are always banging on
about how NHS resources are near break-
ing point. But I have some reservations.
The first is the most basic — I’m not sure
this is quite the cash windfall it’s made out
to be. While Boris has assured us that ‘this
is £1.8 billion of new money [that] wasn’t
there ten days ago’, Sally Gainsbury, senior
policy analyst at the Nuffield Trust think-
tank, said that the money was actually from
hospitals that had accumulated it by making
savings in capital expenditure introduced by
Theresa May. She said it was ‘the equivalent
of giving someone cash then banning them
from spending it, only to expect cheers of
jubilation when you later decide they can
spend it after all’.
But still, wherever it’s come from, it’s
better to have it to spend than not. The big-
ger issue is that despite promises of more
money, those on the coalface so rarely get
to see it. I never turn up to work after an
announcement like this to find an extra
nurse or doctor. Dieticians or occupational
therapists don’t materialise after a politi-
cian tells us we’ll receive more money for
the NHS. It’s an ongoing joke at work about
where the money actually goes.
I work in mental health, and talking to
colleagues from a range of mental health
services it seems that despite promises from
politicians, we haven’t had an increase in
staff or resources. Waiting lists have been
brought down slightly over the past few
years, but that’s simply a result of a variety
of sleight-of-hand techniques, such as shift-
ing responsibilities back to GPs (who are
struggling as a result), increasing thresholds
for patients receiving care, or reducing the
amount of treatment patients actually get.
Too often extra cash just gets poured
into debts or goes to offset rising costs. The
legacy of the Blair years was PFI — private
finance initiative — which saw hospitals get
into hugely costly contracts with privateproviders. These still cripple many of them
today. We need to centralise all the PFI
debt because until we do this, extra money
getting to frontline services is always going
to be dependent on whether the hospital
is in debt or not. This is the absolute crux
of it. Yes, by all means give the NHS more
money, but please make it come with a rider:
that it has to be invested in frontline servic-
es. It has to be spent on something that actu-
ally helps patients.
It would be much better also if it was
given to something very specific and clear,
otherwise there’s too much of a temptation
for hospitals to use it on things with no clear
impact — managing debts, wasteful van-
ity projects or yet more managers. Why not
make it incredibly specific?
Cataract operations, for example. Cata-
racts are associated with increasing social iso-
lation and decreasing independence. Sorting
them out actually saves money elsewhere,
because poor vision is linked to a raised
risk of falls, fractures, road traffic accidents,
depression, anxiety and dementia, to name
but a few. The operation is quick and easy.
Yet NHS clinical commissioning groups, in
an attempt to make savings, are increasingly
denying them to patients. That £1.8 billion
could fix around two million eyes. It would
pay for everyone currently waiting for
a cataract operation for the next six years.
That’s quite a legacy. It’s not going to solve
all the problems, but it would mean a real,
demonstrable increase in quality of life for
a lot of people who are currently being given
quite a raw deal by the NHS.
If this doesn’t float Mr Johnson’s boat,
then increased spending on prevention and
primary care also makes sense. Give the
money directly to GPs, insisting they use it
to increase out-of-hours appointments.
Or give it to mental health. Considering
the economic and social burden of psychiat-
ric disease, let alone the human suffering of
it, this would make sense. But insist it is only
used to fund more nurses. Then we’d really
see the impact on the ground and, most
importantly, so would patients.Dr Max Pemberton is a columnist for the
Daily Mail.Dams, lives and statisticsThe town of Whaley Bridge, Derbyshire,
was evacuated after heavy rainfall caused
the partial collapse of a reservoir slipway.
No one has been killed in a dam collapse in
Britain since 1925, but the worst incidents
up to that date were:
— Dale Dyke, Sheffield, 1864. Puddle clay
core of dam fractured while the reservoir
behind it was being filled for the first time.
244 were killed.
—Biberry Dam, Holmfirth, W. Yorkshire,- Dam had settled since construction
17 years earlier. Water overtopped the dam
during a storm, causing collapse. 81 died.
— Whinhill Dam, Greenock, 1835.
Embankment had been undermined by
burrowing rats and moles. 31 died.
— Dolgarrog, N. Wales, 1925. Leak in
upper dam caused its failure. Cascading
water caused collapse of lower dam. Later
examination suggested the foundations had
been unsatisfactory. 16 were killed.
The fruits of no dealThere were more claims that supplies of
fruit and vegetables will be constrained in
the event of a no-deal Brexit. What is our
balance of trade in food with the EU?
(Figures represent billions of pounds)
imports exports
Fruit and vegetables 11.1 1. 2
Meat 6.7 1.
Cereals 3.9 2.
Dairy and eggs 3.2 1.
Fish 3.2 1.
Source: HMRCWho pays income tax?According to an analysis by the IFS, 43 per
cent of adults pay no income tax at all.
Earnings p.a. of the 57 per cent who do:
50th percentile £22,
90th percentile £51,
99th percentile £162,
99.5th percentile £236,
99.9th percentile £648,Piling on the poundsBBC presenter Michael Buerk claimed that
obese people save the NHS money by dying
earlier. Is he right?
— A study by the Dutch National Institute
for Public Health and the Environment in
2008 looked at the lifetime healthcare costs
of three theoretical groups of 20-year-olds:
obese; healthy-living; and smokers.
— The obese group, it concluded, would live
an average of 59.9 further years and incur
lifetime healthcare costs of €250,000.
— The healthy group would live 64.4 more
years and incur costs of €281,000.
— The smokers would live 57.4 more years
and incur costs of €220,000.BAROMETER