One of my most poignant memories of being a Minister was trying to secure some benefits when I offered more money to the Welsh NHS in their budget settlement. I wanted them to appoint more Consultants, doctors and nurses to clear hospital backlogs and shorten waiting lists. As soon as I revealed I had found a substantial sum from other budgets to offer to the NHS, a vanishing trick started with plenty of other ways appearing to use or lose the money on offer without hiring more medical staff.
Listening yesterday to the offer of £500 million extra over two years to the NHS in England made me ask what will we buy with this? The politics was well thought through. The offer of extra money demonstrates Ministers’ concerns. It tackles head on the likely response to the question why are A and E departments under too much pressure. If the NHS counters by saying their budgets have not gone up enough to cater for demand, the extra money answers that criticism. Minsters can say they cared, they did what Ministers can do by voting the money. Now it is up to the NHS managers to deliver with better A and E services.
Then I heard the usual efforts to claim that £500 million would soon vanish. Some said it would be diverted to paying for social services, so more elderly people could be taken care of in the Community and not sent to A and E. Some said it was simply not enough. Others implied they would not be rushing to spend it on more Consultants and nurses to ensure the work could be done in a timely and professional way.
The government has said more money must be allied to reform. That was Mr Blair’s mantra, though he failed to deliver much of the reform. They say this, as they understand the problem. If every problem is perceived to be caused by a lack of money rather than by bad management, failure to run an efficient and high quality service, or failure to spend wisely on technology to assist good staff, then it will always be possible to use that excuse. If the government gives £250 m and there are still problems in A and E the answer can still be that £250 m was not enough.
The money we learn is to be given to a limited number of A and E departments that are under particular stress. That makes sense if it is the result of varied levels of demand compared to the size of the unit. It is less sure footed if it means more money is given to the departments and hospitals which have performed worse. There is a danger that awarding more money selectively can reward poor conduct and penalise good practice.
It is easier pointing out the problems than solving them. The government does need to insist on sensible reforms to make sure this time the extra money buys something we want and need. It should ensure that extra money is allied to better performance in those A and E departments that are struggling.