Eh?

A Conservative administration would increase health spending by up to an extra £28 billion a year, a leading moderniser has told The Times. Andrew Lansley, the Shadow Health Secretary, gave a long-term commitment that under the Tories health spending will rise to take up an extra 2 per cent of GDP.

Is Lansley still under the delusion that the problem with the NHS is a lack of money? I thought we\’d just tested that theory to destruction?

It\’s the way we spend it, not the amount we spend, which is the problem.

11 comments on “Eh?

  1. Someone remind me, what’s the point of the Tories again? Are they exclusively for people who approve of everything Gordon is doing but don’t like him because he’s boring and Scottish…?

  2. Don’t the Tories want to get back into power? El Gordo will be laughing over his scots oats this morning while he reads this. In the ‘who can spend the most’ game Labour will always win.

  3. In today’s news:

    “The new GP contract in England has cost the government £1.76bn more than predicted in its first three years but productivity has fallen, says a report. ”
    http://news.bbc.co.uk/1/hi/health/7266691.stm

    This is all part of our wonderful, enduring legacy from Tony Blair but then he did have so many other niggling, little things to worry about, like the Iraq war. What’s more, also in today’s news we have this:

    “The number of deaths linked to hospital bug Clostridium difficile has soared in England and Wales, figures from the Office for National Statistics show.

    “Between 2005 and 2006 the number of death certificates which mentioned the infection rose by 72% to 6,480, most of which were elderly people.”
    http://news.bbc.co.uk/1/hi/health/7268578.stm

    That’s our National Health Service – “the envy of the world,” according Professor Lord Darzi – where twice as many people die from hospital acquired infections as are killed on the roads in Britain through traffic accidents.

    Not to worry. C.diff mainly affects pensioners. Look on the brightside, it cuts government spending though consequential savings on state pensions, which is excellent news for prospects of cutting taxes.

  4. “The new GP contract in England has cost the government £1.76bn more than predicted in its first three years but productivity has fallen, says a report. ”

    I really hate the use of “but” in sentences like that. If you spend more on something that’s currently underresourced, of course *productivity* (i.e. output divided by cost) will fall… the question is whether the rise in output justifies the extra investment in resources.

    [also, note the comments in the linked article that MSRA and C-diff deaths in the UK per patient are equivalent to those seen in other developed countries. I don’t know whether that’s true, but brazenly lying about it would be a bold strategy…]

  5. “comments in the linked article that MSRA and C-diff deaths in the UK per patient are equivalent to those seen in other developed countries”

    Talking of C-diff, did anyone notice how the number of people dying from this per year is double the number dying on the roads? Yet do we see the kind of focus on hospital deaths that we see on road deaths?

  6. john b:

    “f you spend more on something that’s currently underresourced, of course *productivity* (i.e. output divided by cost) will fall…”

    What sort of logic is this? As someone who has worked in industry most of his life, I can tell you that underresourcing often creates bottlenecks that restrict system productivity. Extra resources directed at those bottlenecks can not only increase output but also increase productivity (output divided by cost).

    But the real question here is why Andrew Lansley thinks that spending 2% more of GDP on ‘health’ services (even if it were used ‘efficiently’) would improve health. Can he demonstrate any correlation (or causality) between government ‘health’ spending and (say) life expectancy?

  7. What sort of logic is this? As someone who has worked in industry most of his life, I can tell you that underresourcing often creates bottlenecks that restrict system productivity.

    Specific, targeted spend on easing bottlenecks: yes, great. But you’re thinking tactically rather than strategically – blimmin’ engineers 😉

    A massive across-the-board step change to improve service provision will always increase costs per unit – in the private sector, your logic for doing it would be that the revenue gains you could realise from your superior product would be even greater. And your metric for whether or not your plan was a success is your change in total profitability, not your change in production efficiency.

    Obviously, with the NHS free at the point of use, you don’t have that comparison in black-and-white. But we know outcomes have improved with the extra spending, and we can in theory place a value on those outcomes. The interesting question is, is the overall value higher than the overall cost – if we take whatever the usual B/CA value of a QALY [*] is, and multiply that by the number of extra QALYs that have been provided by the changes, does that exceed the rise in spending?

    [*] quality adjusted year of life

  8. “But the real question here is why Andrew Lansley thinks that spending 2% more of GDP on ‘health’ services (even if it were used ‘efficiently’) would improve health.”

    Britain’s population is ageing. It’s therefore highly likely that one way or another we will need to commit a larger percentage of GDP to healthcare in future – as will most other west European countries for the same reason.

    For the most reliable internationally comparable figures on healthcare spending, try:
    http://fiordiliji.sourceoecd.org/pdf/fact2006pdf/10-01-04.pdf

    A delay is inevitable in producing collated international figures on healthcare spending. As can be confirmed from the figures shown, per capita spending in Britain on healthcare was less than the OECD average. Inefficient management and structures in the NHS only compounds the problems from under-resourcing.

    By European standards, in independent assessments, the NHS rates as only mediocre:

    “Britain’s health system is among the worst in Europe, according to a survey. The poll of all EU member states plus Switzerland and Norway ranks Britain 17th out of 29 countries for patient satisfaction. Its rating was dragged down by waiting lists, MRSA infection rates, access to cancer drugs and dentists as well as cancer survival rates.”
    http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/02/nhealth102.xml

  9. John B:

    “Specific, targeted spend on easing bottlenecks: yes, great. But you’re thinking tactically rather than strategically – blimmin’ engineers

    A massive across-the-board step change to improve service provision will always increase costs per unit – in the private sector, your logic for doing it would be that the revenue gains you could realise from your superior product would be even greater. And your metric for whether or not your plan was a success is your change in total profitability, not your change in production efficiency.”

    For a start, although originally trained as a physicist/engineer, that was quite some time ago I currently earn my living advising businesses on strategy. Most people don’t even know what strategy is, but that’s another story.

    Secondly, there are plenty of instances where large changes in investment (over fairly short timescales) have reduced costs and increased productivity. If you doubt this, I suggest you research the history of the semiconductor industry – I have worked in one of the most competitive parts of this industry (memory) where huge investment has led to rapidly falling unit costs.

  10. HJ and Bob B:

    In reading (both) your posts, I couldn’t quite follow–especially where came in the discussion of “strategic.” I’m not at all sure I understand what is meant by “strategic” in the sense that you both seem to use.

    My own sense of the term is that it applies to a type of planning for future action in which the environment is characterized as containing other, also planning, entities and in which the thinking of each must subsume the likely actions taken by other with antithetical actions. The classic are “war-gaming” scenarios characterized by optimization which includes proper randomization of a portion of those actions (a la von Neumann). Is this the definition of “strategy” you use? Or do you use the term simply to describe what most would call a “well-thought-out plan?”

    I don'[t know anything about these things and you guys seem to–so I thought I’d ask.

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