Tory ‘myth-busting’ ‘facts’ on the NHS reforms are just more spin

By Kathryn Rose

According to Tim Montgomerie of Conservative Home “Mr Lansley’s office has also supplied ConHome with some myth-busting facts about the NHS reforms.” Here I shall explore just how ‘myth-busting’ they are and to what extent they simply serve to discredit the truth in order to portion-out spin in the place of truth.

Alleged Myth: The NHS is being cut.

To this Lansley’s office responds with the claim that:

“We are increasing the NHS budget above inflation year-after-year”

The truth: “The NHS will need to make efficiencies to deal with rising demand from an ageing population and the increased costs of new technology” (CSR, 2.11).

Yet surely these changes themselves will cost money?

“The one-off cost of our changes will be £1.4 billion”

If we compare the re-organisation cost (£1.4 billion), to the increase in the Departmental Expenditure Limit over the first 3 years (£4.6 billion), then we can see that once you take away the money spent on the re-organisation the Health budget only increases by £3.2 billion between 2010-11 and 2012-13.

The Department of Health’s budget includes ‘an additional £1 billion a year for social care through the NHS’ (CSR, 2.10). Even if we assume that the NHS only gives half of this to Social Care: the £3.2 billion increase in health spending is reduced to £1.7 billion over the first 3 years. A £1.7 billion increase divided by the 2 years following the starting year = £0.85 billion a year actual increase in money that the Department of health can spend. The lowest of the in-year budgets is £103.8 billion.

To put it simply, if a £0.85 billion yearly increase on a budget of £103.8 billion is ‘increasing the NHS budget above inflation year-after-year’ then Lansley is assuming we’re heading for massive deflation.

Dubious claim: “increasing the NHS budget above inflation year-after-year…something which Labour opposes”.

In Labour’s pre-election budget they planned to spend £104.1 billion on Health in 2010-11; the Conservative-led Spending Review announced that for the same year they plan to spend £103.8 billion: Labour was going to spend more.

Dubious statement: “any savings we make will be ploughed straight back into patient care”.

Truth: “Any savings we make” doesn’t seem a very confident statement does it? Maybe this is because after spending £1 billion on making people redundant the NHS will then re-hire many of them:

“A plausible range of proportions of staff made to no longer be employed is between 30% and 50%, with 40% being taken as the best estimate at this stage (as the midpoint of this range)…Therefore, the table below illustrates a range of 50% – 70% of staff transferring from PCTs and SHAs to the new structures, with 60% being taken as a midpoint of this range”

Whilst it is good to hear that an estimated 60% of staff will be able to regain employment in jobs similar to their old ones; it has to be questioned how much will be saved by making people redundant then having them re-hired by GP Consortia.

Alleged Myth: The NHS doesn’t need any change

Alleged Fact: “Someone in this country is twice as likely to die from a heart attack as someone in France. Survival rates for some cancers are amongst the worst in the OECD. Premature mortality rates from respiratory disease are worse than the European average. The number of managers in the NHS doubled under Labour, and productivity went down year-on-year.”

Truth: According to the World Health Organisation’s most recent figures, the difference in life expectancy between the UK and France is less than 2 years, it’s also only 0.2 years different from Germany and life expectancy for the UK is higher than the EU average. This is despite years of playing catch-up with France. The UK’s per person health expenditure was only 65% of the French level in 1997. That figure rose to 85% of French expenditure per person in 2008.

Lansley’s office neglects to mention that according to the World Health Organisation the UK percentage of public investment in medicines as a total of pharmaceutical investment increased by over 20% over a 9 year period. Meanwhile salaries as a percentage of total public health expenditure fell by just under 2% over the same period leading up to 2008 which is the most recent data available. The number of nurses per person also increased noticeably under Labour. In some areas we are doing worse than average but in other ones such as life expectancy we are doing better.

In essence this non-answer is a simple attempt by the Conservative-led government to suggest that a need for improvement automatically demands the plan they have in mind; spotting an area for improvement doesn’t mean they know how to fix it.

Alleged Myth: GP consortia will be forced to use the private sector.

Alleged Fact: “It will be up to GP consortia to decide their own arrangements.”

Truth: The consortia will be forced to take the services which enable them to be the most competitive, so if a private company can afford to undercut a public one: ‘Monitor will have concurrent powers with the Office of Fair Trading to apply competition law to prevent anti-competitive behaviour'(NHS White Paper 4.27)- they’ll be under pressure to take the most competitive bid.

Alleged Myth: These changes are a revolution.

Alleged Fact: “Our proposals are an evolution of plans which governments of all parties have introduced over the past twenty years. Giving power to GPs has been around for the last two decades, with Labour setting up ‘practice-based commissioning’ when they realised that abolishing GP fundholding was a mistake.”

The Truth: The British Medical Journal has reported that:

“Department of Health officials…giving evidence to MPs on the parliamentary health select committee as part of its inquiry into commissioning said on 19 October that the benefits envisaged by previous approaches, such as world class commissioning and practice based commissioning, had not materialised”.

Attempts at strategies like this have failed twice, but when they were tried the Government left itself room for manoeuvre; this plan is in a similar vein to the failures but without an escape route.

In the sense that it is demolishing an old system to force a new system in to place it is revolutionary. In the sense of being a new idea it is not.