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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The Daily Mail attacks its own campaign over Guantanamo Bay story

“Utter hypocrisy.”

Fresh from planning the metropolitan liberal revolution, in which he called on Britain to “rise up” against Brexit, everyone’s favourite former Labour Prime Minister Tony Blair has waded into public discourse again. This time, to attack the Daily Mail.

The Mail’s front page story today – headlined “I.S. Suicide Bomber You Paid £1million” – condemns “intense lobbying from Tony Blair’s government” for the release of a British-born Guantanamo detainee called Jamal al-Harith (or Ronald Fiddler, the name he was given at birth) in 2004, who has committed a suicide attack on behalf of Islamic State.

Blair is enraged by the “utter hypocrisy” of the paper – it was the Mail that led a campaign for al-Harith’s release at the time, running an article headlined “Freedom At Last For Guantanamo Britons” when he was freed.

“I would not normally respond to daily stories about events which happened during my time in office but on this occasion I will do so, given the utter hypocrisy with which this story is being covered,” Blair comments in a post on his website.

“It is correct that Jamal al-Harith was released from Guantanamo Bay at the request of the British Government in 2004. This followed a Parliamentary and massive media campaign, led by the Daily Mail, the very paper that is now supposedly so outraged at his release and strongly supported by the then Conservative Opposition.”

He also points out that the Jihadi, who blew himself up in Iraq this week, was paid compensation under the Tory government in 2010.

 

Your mole realises that this story will cause much heartache for its leftier readers – so do address your dilemma by telling us who you side with in this Alien vs. Predator setup:

 

I'm a mole, innit.