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. He is on Twitter, almost continously, as @JonnElledge.

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Supreme Court Article 50 winner demands white paper on Brexit

The Supreme Court ruled Parliament must be consulted before triggering Article 50. Grahame Pigney, of the People's Challenge, plans to build on the victory. 

A crowd-funded campaign that has forced the government to consult Parliament on Article 50 is now calling for a white paper on Brexit.

The People's Challenge worked alongside Gina Miller and other interested parties to force the government to back down over its plan to trigger Article 50 without prior parliamentary approval. 

On Tuesday morning, the Supreme Court ruled 8-3 that the government must first be authorised by an act of Parliament.

Grahame Pigney, the founder of the campaign, said: "It is absolutely great we have now got Parliament back in control, rather than decisions taken in some secret room in Whitehall.

"If this had been overturned it would have taken us back to 1687, before the Bill of Rights."

Pigney, whose campaign has raised more than £100,000, is now plannign a second campaign. He said: "The first step should be for a white paper to be brought before Parliament for debate." The demand has also been made by the Exiting the European Union select committee

The "Second People's Challenge" aims to pool legal knowledge with like-minded campaigners and protect MPs "against bullying and populist rhetoric". 

The white paper should state "what the Brexit objectives are, how (factually) they would benefit the UK, and what must happen if they are not achieved". 

The campaign will also aim to fund a Europe-facing charm offensive, with "a major effort" to ensure politicians in EU countries understand that public opinion is "not universally in favour of ‘Brexit at any price’".

Pigney, like Miller, has always maintained that he is motivated by the principle of parliamentary sovereignty, rather than a bid to stop Brexit per se.

In an interview with The Staggers, he said: "One of the things that has characterised this government is they want to keep everything secret.”

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.