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.
Hi – I’m reading “Coalition: The Inside Story of the Conservative-Liberal Democrat Coalition Government” by David Laws and wanted to share this quote with you.
“On 23 October, Simon Stevens made the case publicly that the NHS needed around £8 billion more over the next five years. It seemed to many in the Tory Party and in the media to be a large sum of money. But this was not the original amount estimated. Simon Stevens had been working on his financial projections for the health service for some weeks. He and his staff had been making best-and worst-case forecasts of the demand for NHS services, as well as best-and worst-case scenarios for efficiency savings. Eventually, based on credible efficiency savings, Simon and his team had actually arrived at an estimate that the NHS would need around £15—16 billion extra per year by the end of the next parliament. This was a large sum, but according to the figures prepared for the NHS chief executive this was around the amount needed just to maintain service quality. But when this number was shared with advisers and others in 10 Downing Street there was immediately a sharp counter-reaction. ‘You have got to be joking,’ was the view from No. 10. The Prime Minister’s advisers made clear that there was no way the government and the Chancellor were going to sign up to a commitment of this size. Simon Stevens was told that if he used the £15—16 billion figure, this would look impossible and excessive. ‘You need to increase your estimates of efficiency savings and get the extra money needed down to a more deliverable sum,’ was the message back from the centre of government. After much consideration, the figures were re-worked with higher efficiency assumptions and the £15—16 billion estimate was suddenly reduced to £8 billion.”
So the generous settlement was far from that
It was always quite clear that Stevens said what they wanted him to say to keep his cushy job. Everyone knew that £22bn savings were unachievable – and exactly that figure is now being cut behind the scenes. I don’t know how they think they’re going to get away with it because it will of course mean that NHS will no longer be free at the point of delivery. In my CLP yesterday we were talking about the possibility of a snap general election – possible with the current state of Labour polling figures – before the proverbial hits the fan. Let’s hope this doesn’t happen and that the tories’ slim majority gets worn away before 2020 (possible if GE expenses overspends result in by-elections).
Difficult to have a “snap” election when you first have to lose a vote of confidence, or have two-thirds of the entire HoC vote FOR an election.
The only other route is to repeal the Fixed Term Act….also not “snap”.
Although I admit that, with Labour currently indulging in its favourite pastime of “stab anyone within reach as long as they’re also Labour”, the leadership would probably welcome an election in the hope the warring factions will unite against a common foe (which I think unlikely, since to blairites the left of anything is an enemy).
So…no “snap” election.
Oh, and the Labour “right” had better start arranging their finances soon, unions are fast losing patience funding a bunch of backstabbers…have a word with Rupert et-al guys…
The tories made the fixed-term parliament act and they can change it.
Why on earth did Simon Stevens not resign over this?
See above.
http://m.content.healthaffairs.org/content/23/3/37.full
I don’t know if you have read the prospectus from the NHS Partners Network, NHS Confederation but I’m sure you will not be surprised. The prospectus is entitled ‘Capital, capacity and capability – Independent sector providers helping to develop
a strong Sustainability and Transformation Plan’ and includes the following:
‘With public sector capital increasingly limited, the NHS will need to consider how it can supplement publicly available capital funding with external investment. The independent sector is well positioned to support this and can access capital from existing corporate balance sheets or the commercial markets to fund new and remodelled services. The independent sector can take a long- term view and secure funding against future assets or funding streams, using direct relationships with funding markets. Engaging with local independent providers early on will help NHS partners understand the potential for investment in the local area across a wide range of health and care services.’
http://www.nhsconfed.org/~/media/Confederation/Files/public%20access/Capital%20capacity%20and%20capability%20%20Independent%20sector%20providers%20helping%20to%20develop%20a%20strong%20STP.pdf
I think the quote is self-explanatory as to why this government is underfunding the NHS .. and why Jeremy Hunt thinks it is a misjudgement for NHS Providers to be asking government and not the commercial markets for external investment.
Privatisation is the agenda….
Of course
A blueprint for replacing the NHS with an insurance market scam, crippled the present NHS system and replace with private sector scam operating from a offshore tax haven.
It seems so
What is absurd Sue is that state capital is more readily available than private capital and is much cheaper
But Hunt is not dealing in facts
As you say, Hunt is not dealing with facts or about where to source funds. This is about the private sector taking control of a commodity, demand for which will never cease. I don’t agree with Max Keiser’s solutions but I think he is right when he suggests that privatised public services offer a useful hedge against more risky investments. A market that will never run dry and a money stream collected on their behalf by Jamie Galbraith’s Predator State.
Indeed
Jeremy is doing his best to assist- shifting capital spend to current to try and hold off impending disaster but making private capital / take over even more urgent.
http://www.huffingtonpost.co.uk/entry/jeremy-hunt-slammed-for-raiding-nhs-repair-funds-to-pay-for-frontline-services_uk_583d8219e4b090a702a634ce?
The construction of the internal market and the destruction of NHS monopsony power = the fattening of the goose for slaughter ie privatisation.
“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.”
Jeremy Hunt has mastered the art of of deception this is the Hegelian dialectic in operation …the solution to the problem being privatisation. which all the crony capitalists are drooling over!
We need to get real the NHS needs around 10% of GDP. I think it is currently about 6.5%. The right hates the NHS; it shows the Friedrich Hayek and Milton Friedman zombification of Economics to be a sham. Despite everything it is still by far the most efficient health system of any major country.
More like 8%
But you are still right
Take your pick:
https://www.kingsfund.org.uk/blog/2016/06/uk-spending-health-care-and-social-care
https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared
And take-care!:
http://www.theregister.co.uk/2016/11/30/investigatory_powers_act_backdoors/
Ah,Richard, you misjudge Jeremy Hunt. The funding policy (never enough) is merely another lever to cripple the NHS to the point where, as Chomsky says:
“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”
Add to that the importance of demoralisation of the staff (a court martial offence when I was in the army) and you have Hunt’s perfect strategy.
It is no longer an economic issue, but one of treason – destruction of the democratic state.
I agree
I feel a book coming on…..
Yes but please take your time whilst I save up for it!
Much obliged…………..
2018….
Could be a poll tax level misjudgement by the Conservatives. There is one sacred cow in British life & P and threatening it is dangerous.
Perhaps if the EU offered to fund it… Lol
Thank you Richard…perhaps your best piece ever. The two short paragraphs which begin ‘The second phrase…’ say everything that needs to be said about this whole sorry mess. They nail the lie woven by Cameron and Osborne and embroidered by the barons of the media and a craven BBC. ..a lie which has now been adopted wholesale by Corbyn and McDonnell. It seems to me that the only hope for the future is to keep on nailing that lie every opportunity you get (I think I once saw you trying in vain to get Andrew Neill to actually engage with the point rather than sneer at it.)
Giving them (all) the benefit af the doubt – which I don’t feel they deserve – perhaps it’s simply that they feel the only way they can get the punters to ‘understand is by pandering to their vaguely grasped idea that running the economy is like running the household budget on the one hand…and to their lack of belief in ‘Magic Money Trees’ on the other.
I earnestly hope that every time you get access to the airwaves via the good offices of dear old Jeremy Vine and the like, you willpull from your pocket a much folded piece of paper on which those two paragraphs are written in your best copper-plate and read them over and over again. The fact that the fool McDonnell has made your task to MAKE the public believe in Magic Money Trees defines the nigh-on impossibility of your task. Good luck!
Thank you
it may not seem it but McDonnell abandoning your ideas and trying to trash you is the biggest blessing in disguise/backhanded compliment possible. Corbyn and McDonnell are a doomed political duo and it would be a shame if your work would be tarnished by association when they inevitably disappear off stage.
Whilst your arguments are inherently political they are also grounded in common sense and logic – which in many senses to my mind is apolitical. There is the political side in terms of what societal priorities should be and then the apolitical part which is the mechanics of a new economics.
I have not regretted my decision
Richard
At this time of Advent I don’t know whether to quote Yeats or Eliot. I think Yeats –
“And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?” after the final verse of the first stanza:”the best lack all conviction, while the worst are full of passionate intensity.
“Rough beast” is economics at last to the rescue of public services. THANK YOU.
Now all we have to do is switch “best” and “worst” around in the first stanza, using good economic sense to show just how utterly wasteful and harmful the Tory neo-liberal/privatisation dogma really is and, as Paul suggests, let the NHS become the poll tax of this government. Have you looked at the great work Prof Dexter Whitfield has done? A great friend of public services.
My next step is to get the medical fraternity to pay attention to the power of economics thinking to undermine Hunt’s health policy.
Please keep up the pressure.
Thanks
I am familiar with Dexter Whitfield’s work
Best
Richard
Inspiring blog, thank you. “The NHS will last as long as there are folk left with the faith to fight for it”, spoke by a Welshman who stood up for his people and his father. His father died in his arms from pneumoconiosis. There are not so many ex-miners alive now but they all feared “The Dust”, that killed David Bevan in 1925 after a lifetime down the mine. In my early twenties I ferried (I was an LP member that had a car and spare time) many an ex-miner to the “pneumo board”, most were carried or helped to walk, few emerged with a positive claim.
70 years ago The Conservatives voted 21 times against the formation of a national health service, before the NHS act passed. The Tories have not changed, they are as mean a bunch of self-interested charlatans [liars] as ever.
Nye Bevan, inspired by his father said – ‘Got to do something about this, can’t go on like this’. A well-funded NHS will drive growth; lets have growth with investment in a “10% GDP NHS”.
NHS – WE CAN AFFORD IT. WE CAN NOT AFFORD NOT TO.
There is an inextricable link between the power and intellect of the labour movement, through the miners and other workers, with the progressive acts of the Atlee government and the formation of the NHS. I saw this first hand as a youth member of the LP in the 60s, the miners and the tin workers in my local branch were intelligent and knowledgeable and gave me many a [hard] lesson to my political generation on social and political history and policy. Thatcher exploited the opportunity to kill off this proud class and took it, never-the-less Labour never fully realised what a proud tradition and knowledgebase it was losing to history and progress. Corbyn, McDonnell et al are my generation and I’m glad I chose to be a Green Party activist, although I miss some friends and the wider political debate in the larger movement of the national LP.
Richard, a brilliant blog, as passionate as anything you’ve written on here before and, I believe, a great launching point for anyone, even a politician, to address the country on an issue in which is of great interest and concern to the majority of voters, and follow up with a(n informed!)critique of the prevailing “household” economic policies.
As far as Hunt is concerned, an online article, the source of which I cannot remember (age and short term memory issue – it could even have been on here!), said this on Brexit that could equally well apply to Hunt):
“Ah, they say, but freed from the constraints of the EU we shall be able to do even better.
“This is a classic example of a well known psychological condition – “giant in chains complex”.
“Sufferers convince themselves that they are endowed with extraordinary abilities and would be destined for dazzling success in life were it not for one single disability, e.g. a speech impediment, which is holding them back and preventing them from realising their full potential.
“The pathological yearning for Brexit [privatisation], the harder [and quicker] the better apparently, is the clearest example of the translation of this unfortunate condition to a national scale ever witnessed in European history. The closest parallel to collective delusion on this scale might be what occurred in 1864 when Denmark convinced itself that it would be a good idea to provoke a military confrontation with Bismarck’s Prussia. It did not end well.”
This may or may not have come through earlier (internet connection is dreadful today)so I’ll repost it now in a slightly different form.
An absolutely brilliant blog, Richard, more passionate a piece than I recall ever having read on here.
The other day I read a piece on Brexit (unfortunately, I can recall where)that seemed to me to sum up the current situation and is as applicable to this situation as it is to Brexit:
“Ah, they say, but freed from the constraints of the EU we shall be able to do even better.
“This is a classic example of a well known psychological condition – “giant in chains complex”.
“Sufferers convince themselves that they are endowed with extraordinary abilities and would be destined for dazzling success in life were it not for one single disability, e.g. a speech impediment, which is holding them back and preventing them from realising their full potential.
“The pathological yearning for Brexit [privatisation], the harder the better apparently, is the clearest example of the translation of this unfortunate condition to a national scale (n)ever witnessed in European history. The closest parallel to collective delusion on this scale might be what occurred in 1864 when Denmark convinced itself that it would be a good idea to provoke a military confrontation with Bismarck’s Prussia.
“It did not end well.”
I deduced that the targets of this opinion were principally David Davies and Liam Fox. Should those targets not now include Jeremy Hunt?
Yes!
Did anyone read John Redwood’s piece in (of all places) the Guardian the other day?
If you want to know how they think and what contemporary Tory la-la land really looks like please read it.
I will go look for it