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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The dog at the end of the lead may be small, but in fact what I’m walking is a hound of love

There is a new, hairy face in the Hovel.

There is a new, hairy face in the Hovel. I seem to have become a temporary co-owner of an enthusiastic Chorkie. A Chorkie, in case you’re not quite up to speed with your canine crossbreeds, is a mixture of a chihuahua and a Yorkshire Terrier, and while my friend K— busies herself elsewhere I am looking after this hound.

This falls squarely into the category of Things I Never Thought I’d Do. I’m a cat person, taking my cue from their idleness, cruelty and beauty. Dogs, with their loyalty, their enthusiasm and their barking, are all a little too much for me, even after the first drink of the day. But the dog is here, and I am in loco parentis, and it is up to me to make sure that she is looked after and entertained, and that there is no repetition of the unfortunate accident that occurred outside my housemate’s room, and which needed several tissues and a little poo baggie to make good.

As it is, the dog thinks I am the bee’s knees. To give you an idea of how beeskneesian it finds me, it is licking my feet as I write. “All right,” I feel like saying to her, “you don’t have to go that far.”

But it’s quite nice to be worshipped like this, I have decided. She has also fallen in love with the Hovel, and literally writhes with delight at the stinky cushions on the sofa. Named after Trude Fleischmann, the lesbian erotic photographer of the Twenties, Thirties and Forties, she has decided, with admirable open-mindedness, that I am the Leader of the Pack. When I take the lead, K— gets a little vexed.

“She’s walking on a loose lead, with you,” K— says. “She never does that when I’m walking her.” I don’t even know what that means, until I have a think and work it out.

“She’s also walking to heel with you,” K— adds, and once again I have to join a couple of mental dots before the mists part. It would appear that when it comes to dogs, I have a natural competence and authority, qualities I had never, not even in my most deranged flights of self-love, considered myself to possess in any measurable quantity at all.

And golly, does having a dog change the relationship the British urban flâneur has with the rest of society. The British, especially those living south of Watford, and above all those in London, do not recognise other people’s existence unless they want to buy something off them or stop them standing on the left of the sodding escalator, you idiot. This all changes when you have a dog with you. You are now fair game for any dog-fancier to come up to you and ask the most personal questions about the dog’s history and genealogy. They don’t even have to have a dog of their own; but if you do, you are obliged by law to stop and exchange dog facts.

My knowledge of dog facts is scant, extending not much further beyond them having a leg at each corner and chasing squirrels, so I leave the talking to K—, who, being a friendly sort who could probably talk dog all day long if pressed, is quite happy to do that. I look meanwhile in a kind of blank wonder at whichever brand of dog we’ve just encountered, and marvel not only at the incredible diversity of dog that abounds in the world, but at a realisation that had hitherto escaped me: almost half of London seems to have one.

And here’s the really interesting thing. When I have the leash, the city looks at me another way. And, specifically, the young women of the city. Having reached the age when one ceases to be visible to any member of the opposite sex under 30, I find, all of a sudden, that I exist again. Women of improbable beauty look at Trude, who looks far more Yorkie than chihuahua, apart from when she does that thing with the ears, and then look at me, and smile unguardedly and unironically, signalling to me that they have decided I am a Good Thing and would, were their schedules not preventing them, like to chat and get to know me and the dog a bit better.

I wonder at first if I am imagining this. I mention it to K—.

“Oh yes,” she says, “it’s a thing. My friend P-J regularly borrows her when he wants to get laid. He reckons he’s had about 12 shags thanks to her in the last six months. The problems only arise when they come back again and notice the dog isn’t there.”

I do the maths. Twelve in six months! That’s one a fortnight. An idea begins to form in my mind. I suppose you don’t have to be a rocket scientist to work out what it is. But no. I couldn’t. Could I?

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 28 April 2016 issue of the New Statesman, The new fascism