Lots of excitement this morning across the blogosphere about an interview that Andrew Lansley gave to The Times. Both The Times and Telegraph have interpreted Mr Lansley's remarks as a commitment to increase NHS spending even faster than Labour and to increase spending as a percentage of GDP - perhaps by as much as £28bn.
This morning ConservativeHome has spoken to people in the health and Treasury teams - as well as CCHQ - and have been told that there are no plans for the Tories to spend more on health than is planned by Labour. The Tory commitment is to match Labour until 2011 and further intentions have not been decided.
We've read and re-read Mr Lansley's remarks and can see why The Times made the conclusions that it did but are satisfied with the assurances we've received from party insiders. As Peter Hoskin writes at Coffee House: "If ten years of Blair and Brown have taught us anything, it's that increased inputs don't necessarily equate to improved outputs. Today's National Audit Office report only serves to underline this."
What we're told Lansley does believe is that without big improvements in public health - Cameron has promised him that he will be Secretary of State for Public Health - and improvements in NHS productivity there is a real danger that the NHS will swallow up a much bigger slice of the national economy. The aim, however, is to harness more private resources and know-how in order to help avoid this.
Lansley actually points to the natural increases caused by an increasing and aging population, and the introduction of more and constly medical treatments, as naturally leading to more spending, but then notes that much higher spending as a proportion of GDP would be undesirable. He also reaffirms commitment to introducing more competiion
Posted by: David | February 28, 2008 at 11:41
Entirely sensible politics, and makes a change to see the paper of Riddell, Miles, Webster and Baldwin- all huge Blair sycophants- actually giving us a fair hearing at last.
Brown must be fuming as the sinners repent.
Posted by: London Tory | February 28, 2008 at 11:45
Brown must be fuming as the sinners repent.
He'll be laughing like a drain. It's a disaster for Lansley who, as always, is simply focused on the producer interest in health.
Posted by: Norman Tebbit's bycycle repair man | February 28, 2008 at 11:52
Really not sure about this article. I note the Editor's robust analysis, but it is seriously capable of misinterpretation. On the whole modernising bit, I strongly suggest we pipe down. There's a bit of a spring in our step and the last thing we want is to upset the (very) many traditional Party supporters by rubbin gheir nose on the change bit yet again.
Posted by: Blue Tongue | February 28, 2008 at 12:56
Sorry but this is CCHQ spin.
Why was Lansley talking about cuts to other departments spending if he wasnt saying that health spending would increase?
Posted by: Geoff | February 28, 2008 at 14:15
The Times has produced the transcript, presumably because they think CCHQ are trying to get away without slapping lansley down.
To me it just all seems horribly niave from Lansley and I wish Cameron hadn't confirmed he would be Health Sec.
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Just to be clear, over the lifetime of a Parliament, you would expect the proportion of health spending to rise as a proportion of GDP?
Yes, because health expenditure in every developed economy, and when you look at the demographics health expenditure is clearly rising in every country as a proportion of its GDP.
But your colleagues around the shadow Cabinet table will see the consequences of this...
It's tough. And we've already set out that it's tough. That means there are places where the future of public expenditure is for it to decline as a proportion of GDP or indeed in some cases in absolute terms in order to manage the overall...
Are we in a situation, with the public health problems that exist now, where you could envisage unsustainable demands? If not, how far away?
No, no. I'm talking about the Wanless projections. There's a gap of something like £30 bn in 2030 depending on the overall public health outcomes. So we're talking over 25 years if we don't achieve better public health outcomes we become potentially unsustainable, or they will be unsustainable in a purely taxpayer funded system.
“America, arguably, is itself moving towards a situation where its healthcare expenditures are unsustainable but they are not all funded out of taxation. Probably half is funded out of taxation and half through employer and personal contributions. But we don't want to get to that position. We are at, what, 9 per cent of GDP. We don't want to get to 14 per cent of GDP. We're going to get probably to 11 simply through the progress of rising health expenditure and life.
Posted by: Mario | February 28, 2008 at 14:28
Lansley is bang on the money.
Posted by: Adam in London | February 28, 2008 at 15:14
British GDP circa $2.15 trillion 2007
UK health spend as percentage of GDP is about 8% per annum - skewed heavily to the celts . This is extremely low by comparison internationally . The NHS mentality ie all health has to be paid for by the state/taxation , has held back the growth of the health sector .
If we spent say 12.5% this would equal £133 billion pa ie a massive increase and still only a modest spend .
The US spends 16% of GDP on healthcare .
Posted by: Jake | February 28, 2008 at 15:43
What people on this site never seem to learn is the people want to see spending on health. They want to see ever increasing amounts of money spent on health.Thankfully the leadership as learned that you have got to convince people the NHS will be given more resouces not less.
What people don`t want to see is taxes wasted on overseas wars that they believe we have no business being involved in. Something else those on this site are out of tune with the people on!
Posted by: Jack Stone | February 28, 2008 at 16:30
Good to have you back Jack. Very sad to see though that you've forgotten that the word 'has' has an aitch (h) in it.
Posted by: Malcolm Dunn | February 28, 2008 at 17:01
What seems to be entirely lacking is any discussion of how to liberate health provision from an inefficient, wasteful, centralised, monolithic state bureaucracy. There is a big difference between the state guaranteeing access to health care and managing the provision of health care. Cameron himself hinted at the way forward when he said that public services should be guaranteed by the state but not necessarily provided by the state. There is room for a lot more imaginative thinking here.
Posted by: johnC | February 28, 2008 at 17:29
The man can't leave it alone.
But he seems to be saying it will rise by 28bn to 11% of GDP. Thats about 3p on income tax by my calculation or the equivalent cuts in other areas like transport and defence, just to break even.
http://news.bbc.co.uk/1/hi/uk_politics/7268409.stm
Posted by: Daniel H | February 28, 2008 at 17:45
But as Lansley points out health spending across all developed countries is rocketing (it's going up as a % of GDP - meaning it's increasing faster than the rate of economic growth) and the US (which has one of the most 'liberated' healthcare sectors in the West) spends 14% of it's GDP on health.
Note - Lansley wasn't talking about NHS spending necessarily, he was talking about health spending. Tinker with supply all you like, if you don't tackle the problem of ever growing demand in healthcare you will end up seeing healthcare bills rocket (whether public or private).
Posted by: Adam in London | February 28, 2008 at 17:47
The electorate is perfectly capable of holding two contradictory views at the same time without giving a fig. Yes, it wants more money spent on the NHS, but then it doesn't want taxes to go up.
We can easily claim spending on healthcare will increase, but it might not be state spending. Or, we can say we're going to strip out waste, but nobody believes that.
The real solution is to fund people to buy health insurance through a voucher system so everybody is funded equally according to their needs, but they are responsible for arranging their cover with competing providers, all of whom have to cover a set range of things so they cannot exclude pre-existing or expensive conditions. The state controls the rate of growth of state spending, people can top up if they want extras.
The state would fund a universal ambulance service and A&E centres but once you go past A&E, your insurance pays. This way you maintain the "universal" element of the service, but you unleash the competitive forces of the market on the supply side.
The insurers will be fine as long as their risk pool is big enough, so there will be lots of tie-ups with big employers and unions - who in a similar system in Germany are one of the largest health insurers.
I doubt Lansley will ever get close to this as he's an establishment figure who can't use the word "healthcare", he can only say NHS. They're not the same thing and millions of brits who have used insurance based healthcare systems abroad are starting to realise that. He's a relic and should be pensioned off.
Posted by: C List and Proud | February 28, 2008 at 17:48
Why don't we aim initially to do the same things as Nulab but to do them much better i.e. deregulate, simplify systems, introduce proper delegation and accountabilty, and, above all, introduce a modicum of commonsense?
In fact apply best business practices, so people who do well are rewarded and those who foul up badly are sacked "pour decorager les autres".
Posted by: David Belchamber | February 28, 2008 at 17:59
David Belchamber:
Why don't we aim initially to do the same things as Nulab but to do them much better i.e. deregulate, simplify systems, introduce proper delegation and accountabilty, and, above all, introduce a modicum of commonsense?
You mean in a way that is totally opposite to the way Labour have done it (as it has been a rank disaster for them).
I can do nothing but totally agree!
In fact apply best business practices
And those would be?
Posted by: John Leonard | February 28, 2008 at 18:26
David Belchamber:
Why don't we aim initially to do the same things as Nulab but to do them much better i.e. deregulate, simplify systems, introduce proper delegation and accountabilty, and, above all, introduce a modicum of commonsense?
You mean in a way that is totally opposite to the way Labour have done it (as it has been a rank disaster for them).
I can do nothing but totally agree!
However:
In fact apply best business practices
And those would be?
Also what measures of success would people be judged on for you to reward or discipline them?
Posted by: John Leonard | February 28, 2008 at 18:30
"Brown must be fuming as the sinners repent.
He'll be laughing like a drain. It's a disaster for Lansley who, as always, is simply focused on the producer interest in health."
Posted by: Norman Tebbit's bycycle repair man | February 28, 2008 at 11:52
I suspect this is right. With any other party, Labour, Lib/Dems, UKIP, Monster Raving, they would use the publicity to write in to the Times or whatever pushing their message. But Brown knows the Tories are too lazy and will just go back to sleep. And, of course, whatever attributes Lansley has being any good at communicating and politics aren't included.
Posted by: David Sergeant | February 28, 2008 at 19:20
Of course health spending has to go up as a total. People are already spending more of their income on health whether public or private and wish to spend even more. With an ageing and more health concerned population this is a good trend. I'd far rather people increasingly cared about their health and contributed to it. This does not preclude the need to ensure value for money in public delivery.
Posted by: Matt Wright | February 28, 2008 at 22:15
UK health spend as percentage of GDP is about 8% per annum - skewed heavily to the celts . This is extremely low by comparison internationally
UK Public Sector spending on Health as a proportion of GDP has been raised to 8% of GDP, Private spending in the UK on healthcare is low by international standards. Public spending on it is high internationally and not all that low by EU standards.
The US spends 16% of GDP on healthcare
US Public Spending on Healthcare is less than 6% of GDP although it was higher than UK spending as a proportion of GDP in the second half of the 20th century. They spend far more on private healthcare.
What merits are there in even spending what is currently being spent. When it was set up in 1948 spending on the NHS was only 4.5% of GDP, it went down a bit as a proportion of GDP in the mid 1950s towards 4% of GDP, it gradually crept up under successive governments with growth slowing under Jim Callaghan and being stabilised under Margaret Thatcher before under John Major it started shooting up and this has largely continued since.
People who were sick were patched up and sent out again. The major factors in personal health are mainly down to air quality, food and water supply and quality and disposal of sewerage. Improvements in these have been the overwhelming cause of higher life expectancy through the 19th and 20th centuries largely through improved education, technology and prosperity.
No matter how much money is spent on the NHS there are many people for who it will never be enough, no matter how efficiently it is spent or how much is spent it is limited by the supply of available manpower and idiocy of the general population.
Posted by: Yet Another Anon | February 28, 2008 at 23:01
Osbornes attempt to cover this up is a pretty weak one and doesnt wash. Lansley was pretty clear about the policy.
Posted by: James Maskell | February 29, 2008 at 09:23
John Leonard at 18.30:
"Also what measures of success would people be judged on for you to reward or discipline them?"
We agree largely with Nulab over the wider aims (better education and health systems etc) but huge monolithic and bureaucratic structures can never be made to operate efficiently and without a huge wastage of resources if people are not given the opportunity to "own" responsibility for parts of the process.
A proper system of appraisal would deal with the rewards and proper delegation (and what the army calls chains of command) would ascribe blame when there is a foul-up.
To me it is wrong to give someone a handsome pay off when they have totally failed to do the job they have been paid a lot of money to do.
Posted by: David Belchamber | February 29, 2008 at 09:36
"Tories DO NOT plan to spend more on health than Labour". They just pretend, they do.
Posted by: Peter W | February 29, 2008 at 12:14