I did think it was a misjudgment for NHS Providers, less than a year after they had a settlement for the NHS which they themselves described as a good settlement, to say that there isn’t enough money.
And the reason is that when we’re negotiating with the Treasury for extra support for the NHS, if less than a year ago you’ve got the biggest settlement that any government department got, in a period when most government departments have seen their budget cut, and less than 12 months later you’re saying ‘there isn’t enough money, please sir can I have some more,’ then you devalue the currency.
What you do is you risk the NHS not being at the table in these discussions going forward because people will say: ‘Whatever we do, it’s not enough.’
I find this quite extraordinary. Three phases stand out.
The first is ‘misjudgement’. How can it be a ‘misjudgement’ for someone tasked with providing healthcare to a community to say that they are unable to do so with the financial resources they have been given?
I can see that not treating people can be a misjudgement.
I can also see that not meeting NHS clinical guidelines would also be a misjudgement.
And I can even see that sacking the staff required to ensure that the NHS can function may be a misjudgement.
But if, having looked at all the variables and then having concluded that the constraint, given the need to avoid these misjudgements, is a lack of money I cannot conceive of any circumstance where asking for more of the government that has committed to the electorate to deliver the NHS free at the point of delivery can be a misjudgement.
Nor, come to that, can I see how putting the government on notice that financial failure is likely is a misjudgement: that would be best described as prudence for which the minister should note this thanks for having had the situation drawn to his attention.
The second phase to draw attention to is ‘there isn’t enough money’. Let’s be clear about this: there is enough money in the UK to pay for Hinckley Point. And there is enough to pay for Trident. And there is also enough to provide £60 billion of additional liquidity by way of new QE to banks. There is even enough to buy £10 billion of corporate bonds for the Bank of England to hold during the course of this year. But there apparently ‘isn’t enough money’ for the NHS.
But that is not true. Our money supply is limitless: any amount can be created at any time by the stroke of the keys on a computer keyboard. That is how commercial banks create money when making loans. That is how the funds for QE were created.
But if in doubt about this, it’s also the case that the UK government can borrow without any apparent penalty at present. Interest rates remain incredibly low, even on long term bonds. And markets remain desperately short of high quality debt, which is what UK government bonds are. So they are buying all the debt they are offered right now. And that’s useful because at least £60 billion of borrowing will be required to pay for Brexit for which we apparently have enough additional money available despite the need being unknown less than a year ago.
All of which proves there is enough money. To claim otherwise is simply untrue. All we’re short of is a willingness to spend that money on meeting people’s health needs. We aren’t short of money in that case. What we are short of is a willingness to spend it on meeting people’s needs. And that’s not the same thing, at all.
In that case let’s turn to the third phrase, which is ‘you risk the NHS not being at the table in these discussions going forward’. What is Jeremy Hunt really saying here? Does he really mean that if the NHS cannot now meet all healthcare needs within an arbitrary financial limit it will not in future be considered for further funding whatever the demands placed upon it by people who depend on its services? Is he really willing to imply that unless health care managers do the impossible then he will, arbitrarily, let people suffer? And if that is not his meaning, then what is it because I cannot, at present, find an alternative?
So let me offer some advice to Jeremy Hunt. It is this: when suggesting someone has made a misjudgment it is wise to be sure of your facts because if you’re wrong, or if what you’re actually saying disguises a threat of sanction which you cannot deliver without people suffering real (and in this case, painful) consequences then the misjudgement might be yours alone. And in the case of the comments Jeremy Hunt made today that looks to be the case.