Magazine article Public Finance

Four Years to Save the NHS

Magazine article Public Finance

Four Years to Save the NHS

Article excerpt

New Health Secretary Patricia Hewitt has inherited an improving NHS in England. The huge amounts of money pumped into the service over recent years have delivered faster treatment, better facilities and more staff providing better care. Tough targets and performance management have made a difference.

There is a clear strategy too - repeated in the manifesto - that commits the NHS to further cuts in waiting times, improving care for people with long-term conditions and giving patients real choice over how and where they are treated.

Ministers are also committed to using the private sector more, not just to provide extra capacity but to promote competition and help improve quality and efficiency. As an added bonus, the government has promised that Whitehall will be less interfering.

This week's Queen's Speech featured a number of health measures - from a clampdown on dirty hospitals to new measures for patients who wish to redress any problems with their health care. This is an administration that seems to have little doubt about where it is going or what it wants to achieve.

So, with a reasonable record and a clear agenda, what is there to worry about? Well, quite a lot actually.

First, money. Record sums have gone in but most of it is already committed. New pay deals, combined with reduced working hours, rising pension and drug costs and clinical negligence claims, have left precious little for new tasks. As we have seen in recent months, parts of the NHS are running large deficits.

Worse, the boom days of big spending are numbered. The Treasury is warning Richmond House to expect much smaller rises beyond 2008.

In the meantime, Hewitt and her new ministerial team will have to oversee the new system of 'payment by results', where hospitals will be paid by the number and nature of patients they treat against a fixed national tariff. They might not say this very loudly but the aim is to encourage more competition for patients.

All this in turn is intended to encourage tighter cost controls and make hospitals and other providers more responsive to patients. However, it is high-risk stuff. Apart from various technical problems, there is no strategy for what happens when a service fails and, as yet, it is not clear how or if it will work for people with long-term conditions. There is a danger, too, that choice, the other great mantra of the moment, will do most for the able and the articulate. This must be prevented.

We heard rather a lot about targets during the election. In spite of the criticism, the government has lost none of its enthusiasm for setting them. …

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