Hard decisions are being made—but more transparency will help with public opinionby Jennifer Dixon / December 1, 2017 / Leave a comment
It is summer 1997. Frank Dobson, the new Secretary of State for Health, is making his first major decision about the NHS. He meets with Alan Langlands, then NHS chief executive, who spells out how bad the service’s finances are. Langlands tells Dobson bluntly that, on the money available, the NHS cannot both get through the coming winter and meet the Labour manifesto pledge of reducing waiting lists. Dobson agrees, and opts to prioritise the winter, stretching his party’s pledge on waiting lists to cover a longer period.
This scene is described a rollicking new history of the welfare state, The Five Giants by Nicholas Timmins. Among those who remember it must be Simon Stevens, at the time Frank Dobson’s special advisor and now chief executive of NHS England. Today, Stevens finds himself in a familiar place, with money still tight for the health service. And two troubling factors—acute workforce shortages in a period of record employment levels, and a crisis in social care—have made the situation worse.
NHS England received less than it asked for in Philip Hammond’s recent budget. At the end of November, its board met to decide what trade-offs to make. The board intend to protect spending on primary care, mental health and cancer care—with the implication that waiting for elective and some emergency care will suffer. In the face of mounting winter pressures, increased waiting times for non-urgent surgery will be the most likely outcome. This set of priorities is clear to understand and implement and, after all, something has to give. But in the meantime Secretary of State Jeremy Hunt has confirmed the government’s “absolute determination” to meet current targets on waiting times.
Leaving aside any potential differences between NHS England and the Secretary of State, what are the right priorities?
It depends on what the main objective is. If the aim is political, the NHS will surely need to appear to cope over the winter. With social media, failings in emergency care are more visible than those in other areas such as mental healthcare, primary care, and non-urgent surgery. Jeremy Hunt would rather avoid appearing on television against a backdrop of carnage in A&E; justifying the need to lengthen waiting times (which are at historical lows) is obviously preferable. And while the board of…