Lansley's magic trick with NHS waiting times

Whatever we may like to tell ourselves, NHS care is rationed by the amount of money we're willing to

So here's a good one from the savior/killer of the NHS (delete according to taste), Health Secretary Andrew Lansley: the NHS authorities are to be banned from deliberately holding up your operation so they can save a few quid.

From March 2012, PCTs -- the bodies currently responsible for commissioning and paying for your operation -- can no longer enforce "minimum waiting times". Nor can they place a financially-motivated cap on how many of a particular type of operation they'll pay for. If you need an operation, the PCT will be obliged to get it for you, as soon as they can. If it doesn't, its boss will get the sack.

At first glance this looks a bit of a no-brainer. No-one likes waiting for treatment, and the practice of enforcing minimum waiting lists in order to save money is pretty nasty. It was revealed in a rather stomach-churning passage from a report back in July, which warned that PCTs were deliberately increasing waiting times so that some patients would "remove themselves from the waiting list". If they make you wait long enough, the thinking was, you'll get bored and go private; or, you'll die. Either way, you're no longer their problem. Lovely.

It is not exactly clear how widespread the practice was. But the measures Lansley announced on Monday will force commissioners to make treatment decisions based on medical, rather than financial, realities. That's clearly a good thing, so the Health Secretary's announcement has gone down rather well. After the year he's had, that'll come as something of a relief.

What it won't do, though, is stop waiting times from rising. All Lansley has done is to ban PCTs from imposing a minimum waiting time.
Hospitals and consultants -- those actually doing the operations -- can still impose minimum waiting lists, based on an arbitrary number of patients rather than an arbitrary time period. And making patients wait is, from a financial perspective, useful.

Whatever we may like to tell ourselves, NHS care is rationed by the amount of money we're willing to pour into the system. Waiting lists help eke that money out over a longer period. It's no coincidence that they seem to be creeping up while the NHS scrambles to find £20bn of savings. If PCTs really have been letting waiting times grow to save money, it stands to reason that forcibly cutting them back will cost more. That £20bn just got a lot harder to find.

What Lansley's announcement does do, though, is to weaken commissioners' hand over spending decisions, while leaving the power with hospitals. That's the exact opposite of what was promised by the ungainly Health and Social Care Bill, which was meant to devolve power to those closest to the patients. Devolution, apparently, can stuff it.

None of this is to say that minimum waiting times were a good thing, as in most cases they're probably not. But, for most patients, this latest announcement won't cut waiting times. With the NHS still chasing those savings, they're likely to keep creeping up.

It does, though, give Lansley a neat response to all those opposition attack lines about him having dumped Labour's 18-week waiting time target. Now whenever Andy Burnham pipes up with that one, he can just point to this latest statement and blame waiting lists on NHS managers. That won't make him many friends in the health service, but it might win him a few political points.

Jonn Elledge is the editor of EducationInvestor.

Jonn Elledge is the editor of the New Statesman's sister site CityMetric. He is on Twitter, far too much, as @JonnElledge.

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Is there such a thing as responsible betting?

Punters are encouraged to bet responsibly. What a laugh that is. It’s like encouraging drunks to get drunk responsibly, to crash our cars responsibly, murder each other responsibly.

I try not to watch the commercials between matches, or the studio discussions, or anything really, before or after, except for the match itself. And yet there is one person I never manage to escape properly – Ray Winstone. His cracked face, his mesmerising voice, his endlessly repeated spiel follow me across the room as I escape for the lav, the kitchen, the drinks cupboard.

I’m not sure which betting company he is shouting about, there are just so many of them, offering incredible odds and supposedly free bets. In the past six years, since the laws changed, TV betting adverts have increased by 600 per cent, all offering amazingly simple ways to lose money with just one tap on a smartphone.

The one I hate is the ad for BetVictor. The man who has been fronting it, appearing at windows or on roofs, who I assume is Victor, is just so slimy and horrible.

Betting firms are the ultimate football parasites, second in wealth only to kit manufacturers. They have perfected the capitalist’s art of using OPM (Other People’s Money). They’re not directly involved in football – say, in training or managing – yet they make millions off the back of its popularity. Many of the firms are based offshore in Gibraltar.

Football betting is not new. In the Fifties, my job every week at five o’clock was to sit beside my father’s bed, where he lay paralysed with MS, and write down the football results as they were read out on Sports Report. I had not to breathe, make silly remarks or guess the score. By the inflection in the announcer’s voice you could tell if it was an away win.

Earlier in the week I had filled in his Treble Chance on the Littlewoods pools. The “treble” part was because you had three chances: three points if the game you picked was a score draw, two for a goalless draw and one point for a home or away win. You chose eight games and had to reach 24 points, or as near as possible, then you were in the money.

“Not a damn sausage,” my father would say every week, once I’d marked and handed him back his predictions. He never did win a sausage.

Football pools began in the 1920s, the main ones being Littlewoods and Vernons, both based in Liverpool. They gave employment to thousands of bright young women who checked the results and sang in company choirs in their spare time. Each firm spent millions on advertising. In 1935, Littlewoods flew an aeroplane over London with a banner saying: Littlewoods Above All!

Postwar, they blossomed again, taking in £50m a year. The nation stopped at five on a Saturday to hear the scores, whether they were interested in football or not, hoping to get rich. BBC Sports Report began in 1948 with John Webster reading the results. James Alexander Gordon took over in 1974 – a voice soon familiar throughout the land.

These past few decades, football pools have been left behind, old-fashioned, low-tech, replaced by online betting using smartphones. The betting industry has totally rebooted itself. You can bet while the match is still on, trying to predict who will get the next goal, the next corner, the next throw-in. I made the last one up, but in theory you can bet instantly, on anything, at any time.

The soft sell is interesting. With the old football pools, we knew it was a remote flutter, hoping to make some money. Today the ads imply that betting on football somehow enhances the experience, adds to the enjoyment, involves you in the game itself, hence they show lads all together, drinking and laughing and putting on bets.

At the same time, punters are encouraged to do it responsibly. What a laugh that is. It’s like encouraging drunks to get drunk responsibly, to crash our cars responsibly, murder each other responsibly. Responsibly and respect are now two of the most meaningless words in the football language. People have been gambling, in some form, since the beginning, watching two raindrops drip down inside the cave, lying around in Roman bathhouses playing games. All they’ve done is to change the technology. You have to respect that.

Hunter Davies is a journalist, broadcaster and profilic author perhaps best known for writing about the Beatles. He is an ardent Tottenham fan and writes a regular column on football for the New Statesman.

This article first appeared in the 05 February 2015 issue of the New Statesman, Putin's war