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 edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.

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Theresa May's U-Turn may have just traded one problem for another

The problems of the policy have been moved, not eradicated. 

That didn’t take long. Theresa May has U-Turned on her plan to make people personally liable for the costs of social care until they have just £100,000 worth of assets, including property, left.

As the average home is valued at £317,000, in practice, that meant that most property owners would have to remortgage their house in order to pay for the cost of their social care. That upwards of 75 per cent of baby boomers – the largest group in the UK, both in terms of raw numbers and their higher tendency to vote – own their homes made the proposal politically toxic.

(The political pain is more acute when you remember that, on the whole, the properties owned by the elderly are worth more than those owned by the young. Why? Because most first-time buyers purchase small flats and most retirees are in large family homes.)

The proposal would have meant that while people who in old age fall foul of long-term degenerative illnesses like Alzheimers would in practice face an inheritance tax threshold of £100,000, people who die suddenly would face one of £1m, ten times higher than that paid by those requiring longer-term care. Small wonder the proposal was swiftly dubbed a “dementia tax”.

The Conservatives are now proposing “an absolute limit on the amount people have to pay for their care costs”. The actual amount is TBD, and will be the subject of a consultation should the Tories win the election. May went further, laying out the following guarantees:

“We are proposing the right funding model for social care.  We will make sure nobody has to sell their family home to pay for care.  We will make sure there’s an absolute limit on what people need to pay. And you will never have to go below £100,000 of your savings, so you will always have something to pass on to your family.”

There are a couple of problems here. The proposed policy already had a cap of sorts –on the amount you were allowed to have left over from meeting your own care costs, ie, under £100,000. Although the system – effectively an inheritance tax by lottery – displeased practically everyone and spooked elderly voters, it was at least progressive, in that the lottery was paid by people with assets above £100,000.

Under the new proposal, the lottery remains in place – if you die quickly or don’t require expensive social care, you get to keep all your assets, large or small – but the losers are the poorest pensioners. (Put simply, if there is a cap on costs at £25,000, then people with assets below that in value will see them swallowed up, but people with assets above that value will have them protected.)  That is compounded still further if home-owners are allowed to retain their homes.

So it’s still a dementia tax – it’s just a regressive dementia tax.

It also means that the Conservatives have traded going into the election’s final weeks facing accusations that they will force people to sell their own homes for going into the election facing questions over what a “reasonable” cap on care costs is, and you don’t have to be very imaginative to see how that could cause them trouble.

They’ve U-Turned alright, but they may simply have swerved away from one collision into another.  

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.

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