blog.andrewsteele.co.uk

After the latest Brown budget, sparks are flying over his lack of mention of the NHS. Gordon’s rebuttal is that he shouldn’t have to reiterate what’s already been laid out: he’s ploughing multi-billion sums into the NHS, he’s told us this before, and things are going to stay that way.

The more concerning issue, after what was quite frankly a pretty political budget, is not what strategy lay behind Brown’s choice to announce or emphasise certain uneventful changes over the others (most of the financial tinkering probably not being much more important than “the NHS is staying as it was”), but where it is that all that money he’s already told us he’s ploughing into the NHS is actually going.

There is a simple reason why there is little by way of noticeable improvement across the NHS despite huge and repeated investment: salary rises. The average wage for a GP now sits at around £84,000; you only need twelve GPs, and you’re draining a million pounds every year from the NHS’s not-so-bottomless pit of resources.

Now, I’ll be absolutely fair, pay rises at this level have not been echoed across the board; other NHS jobs have seen more moderate increases, and indeed the government has tacitly acknowledged that the GPs’ pay packet was a cock-up. Sadly, of course, cutting the pay of public sector workers is still a cardinal sin for those in power, so the solution is going to be a pay freeze for GPs — presumably for quite a long time — to bring things back into line.

The exception, people who actually need pay rises, are probably nurses. After three years of medical degree and another three years at clinical school, most doctors have probably invested enough time and effort to be all but set in their career path. Nurses, on the other hand, are something the NHS can neither recruit nor keep hold of once they are employed. Perhaps a financial incentive could actually be of use here?

Another ridiculous drain on NHS money is giving bursaries to students seeking medical-related employment. For example, physiotherapy students receive £2,000 a year with no obligation to pay it back. Another case of necessary incentive? I would argue not: physiotherapy is the second-most-oversubscribed course in the country, after law, with Nottingham University receiving 1,600 applicants for 68 places. Having whittled down this frankly absurd number into an undergraduate population and got them through their degree, there are horror stories of physio graduates being unable to find jobs. So why, when there are far too many of them already is the NHS offering cash to encourage applicants?

The NHS is also screwed in a more general sense. Changes are being made to bring gender equality into the workplace and to reduce doctors’ stereotypically long hours. The latter has the obvious upshot of requiring more doctors to cover all the shifts. The former only becomes a problem when you realise that, in previous times, the NHS was getting a male to female ratio of around 70:30; now, it’s more like 30:70. So, about two thirds of our doctors will probably take maternity leave, and maybe even a few years off, in a way that previous generations simply haven’t.

It is a little unfair to blame the NHS money drain entirely on increased money for staff, however. Other problems are chronic mismanagement and lack of financial accountability, the clichéd public sector flaws.

So, maybe pouring in vast quantities of cash and using what you don’t waste in bureaucracy on giving staff pay rises isn’t the solution?

No reason to mention all this in the budget, of course: better instead to make a pledge to give state schools as much money as their private counterparts, with no stipulation of how much this is or when it could come into effect.

I love New Labour.

Thursday, March 23rd, 2006 13:25 | permalink | trackback