The Tories' health plans are Robin Hood in reverse

David Cameron may insist the Tories are now 'the party of the NHS' but their plans would leave the p

The Conservatives, they tell us, can be trusted with the NHS. School and housing budgets may be up for grabs; but whatever happens, they say, a Tory government will increase spending on the NHS.

That doesn't mean health services won't struggle, though - and those in Labour areas are likely to struggle more than most. The Tories accuse the government of manipulating the formula that distributes money around the NHS, to take cash from affluent rural areas and hand it to inner city ones. A Tory government, they say, would reverse this.

In other words, it would give to the rich, and take from the poor.

Decisions about how much NHS funding goes to each part of the country are made by the zippily-named Advisory Committee on Resource Allocation (ACRA). Its mission is to ensure everyone has roughly the same chance of getting the care they need. A town packed with elderly diabetics, after all, needs more healthcare than one filled with 25-year old fitness instructors; it thus makes sense to give it more money.

The result of all this is a mind-bogglingly complex formula involving population age, poverty, and regional cost differences, that gives some areas vastly more cash than others. Down-at-heel City and Hackney PCT gets £2136 per head; affluent Mid-Essex gets just £1269.
The Tories, though, smell a rat. They claim that Labour's changes to the formula have been less about the best use of scarce funding than about funneling money to their own supporters.

As evidence, they point to the variation in spending on stroke patients. If cash were distributed fairly, they argue, per patient spending should be roughly equal everywhere. In fact, some PCTs spend five times as much as others. The more miserly areas tend to be rural, Conservative, and have large elderly populations. The more generous tend to be urban, youthful, Labour ones.

Government meddling, the Tories conclude, has broken the link between the demands on the health service and the cash that funds it. The formula now places too much emphasis on poverty, and far too little on age, they say. "The current government have deliberately over emphasised socio-economic deprivation," says shadow health minister Mark Simmonds. "They've done this to transfer resources from rural areas to their urban heartlands."

How the Conservatives would correct this is not exactly clear. They talk about the unnecessary emphasis on poverty, but haven't explicitly pledged to correct it. Spokesmen promise that an independent NHS board would increase confidence that spending wasn't manipulated for political reasons. But this rather ignores the facts that a) ACRA already is independent, and b) it's seemingly only the Tories who lack confidence in the current arrangements.

What's more, health economists seem baffled by the Tory criticisms. They accuse the party's number crunchers of all sorts of dodgy things like excluding outliers, and confusing a weak correlation with a strong one. Professor Matt Sutton, of the University of Manchester, notes that plenty of other factors - PCT spending choices, differing costs, and, yes, poverty - can also explain that variation in stroke spending. The King's Fund's John Appleby agrees. "The weightings are arrived at by statisticians and economists, not by putting a finger in the air," he says. The NHS formula is "possibly most sophisticated way of allocating public money in the world."

The truth is the demands for health services are potentially infinite; the money that pays for them anything but. Rural doctors who think they're hard done by should "see the mortality rate in the centre of Manchester," says Appleby. You'd struggle to find anyone in the NHS who didn't think they needed more funding.

No PCT, however poor, will lose money under the Tory plans: NHS budgets never fall, they're simply raised at a slower rate.

But costs in the NHS are increasing far faster than they are in the real world: a lower increase will feel uncomfortably like a cut. Leafy Tory areas would stand to benefit, while poor, Labour-ones lose out.

The Tories claim they'll take politics out of the health service. This is a funny way of showing it.

Jonn Elledge is the editor of Education Investor