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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Metro mayors can help Labour return to government

Labour champions in the new city regions can help their party at the national level too.

2017 will mark the inaugural elections of directly-elected metro mayors across England. In all cases, these mayor and cabinet combined authorities are situated in Labour heartlands, and as such Labour should look confidently at winning the whole slate.

Beyond the good press winning again will generate, these offices provide an avenue for Labour to showcase good governance, and imperatively, provide vocal opposition to the constraints of local government by Tory cuts.

The introduction of the Mayor of London in 2000 has provided a blueprint for how the media can provide a platform for media-friendly leadership. It has also demonstrated the ease that the office allows for attribution of successes to that individual and party – or misappropriated in context of Boris Bikes and to a lesser extent the London Olympics.

While without the same extent of the powers of the sui generis mayor of the capital, the prospect of additional metro-mayors provide an opportunity for replicating these successes while providing experience for Labour big-hitters to develop themselves in government. This opportunity hasn’t gone unnoticed, and after Sadiq Khan’s victory in London has shown that the role can grow beyond the limitations – perceived or otherwise - of the Corbyn shadow cabinet while strengthening team Labour’s credibility by actually being in power.

Shadow Health Secretary and former leadership candidate Andy Burnham’s announcement last week for Greater Manchester was the first big hitter to make his intention known. The rising star of Luciana Berger, another member of Labour’s health team, is known to be considering a run in the Liverpool City Region. Could we also see them joined by the juggernaut of Liam Byrne in the West Midlands, or next-generation Catherine McKinnell in the North East?

If we can get a pantheon of champions elected across these city regions, to what extent can this have an influence on national elections? These new metro areas represent around 11.5 million people, rising to over 20 million if you include Sadiq’s Greater London. While no doubt that is an impressive audience that our Labour pantheon are able to demonstrate leadership to, there are limitations. 80 of the 94 existing Westminster seats who are covered under the jurisdiction of the new metro-mayors are already Labour seats. While imperative to solidify our current base for any potential further electoral decline, in order to maximise the impact that this team can have on Labour’s resurgence there needs to be visibility beyond residents.

The impact of business is one example where such influence can be extended. Andy Burnham for example has outlined his case to make Greater Manchester the creative capital of the UK. According to the ONS about 150,000 people commute into Greater Manchester, which is two constituency’s worth of people that can be directly influenced by the Mayor of Greater Manchester.

Despite these calculations and similar ones that can be made in other city-regions, the real opportunity with selecting the right Labour candidates is the media impact these champion mayors can make on the national debate. This projects the influence from the relatively-safe Labour regions across the country. This is particularly important to press the blame of any tightening of belts in local fiscal policy on the national Tory government’s cuts. We need individuals who have characteristics of cabinet-level experience, inspiring leadership, high profile campaigning experience and tough talking opposition credentials to support the national party leadership put the Tory’s on the narrative back foot.

That is not to say there are not fine local council leaders and technocrats who’s experience and governance experience at vital to Labour producing local successes. But the media don’t really care who number two is, and these individuals are best serving the national agenda for the party if they support A-listers who can shine a bright spotlight on our successes and Tory mismanagement.

If Jeremy Corbyn and the party are able to topple the Conservatives come next election, then all the better that we have a diverse team playing their part both on the front bench and in the pantheon of metro-mayors. If despite our best efforts Jeremy’s leadership falls short, then we will have experienced leaders in waiting who have been able to afford some distance from the front-bench, untainted and able to take the party’s plan B forward.