Saturday, 6 December 2014

The ring-fenced sacred cow

Wednesday’s Autumn Statement arrived on a wave of publicity, pre-announced gambits & commentariat predictions.  But for those of us expecting or being encouraged to expect more detail on English devolution proposals the actual statement failed to live up to the hype.  The Chancellor made an early reference to the “Northern powerhouse” that excited some social media speculation, but beyond a summary of proposals for Greater Manchester & a reference to English Votes for English Laws the subject didn’t progress beyond Mr Osbourne’s pledge that “my door is open to other cities who want to follow”  the example of Manchester.  Reform of stamp duty took the limelight, & reform of English democracy retreated to the sidelines.

The coverage following Wednesday has (Stamp Duty excepted) centred around the analysis that the continued long term public sector spending plan detailed in the Autumn Statement will lead to the lowest proportion of state spending since the 1930s.  A further £15billion reduction in Whitehall spending over the first two years of the next Parliament have been promised (subject to voters’ agreement, of course) under the slogan of “Savings and reform”.  This section of the statement is worth quoting in full:

“We’ve shown in this Parliament that we can deliver spending reductions without damaging frontline public services if you’re prepared to undertake reform.

Crime is down.  Satisfaction with local government is up.

Savings and reform.

We will do exactly the same again.”

All of which is perhaps unsurprising.  Data sourced by the IFS and reported by The Economist illustrates the percentage change in Whitehall departmental budgets between 2010-11 and 2014-15, with Local Government reducing by around 25% and Communities by 45%.  And yet protection remains and grows for certain areas, especially the NHS.

If we go along with the old saw about the NHS being the closest thing England has to a religion, then National politicians appear to be devout believers.  The Chancellor announced a further £2billion every year (yes, every year) to frontline NHS services, alongside £1.2billion investment in GP services.  And who could disagree with more acute care, more nurses, more Doctors, more NHS?  Labour, who see the NHS as their trump electoral card, certainly couldn’t & so promptly announced that the extra £2bn announced by the Chancellor would be added to the £2.5bn they had already pledged should Ed Miliband become Prime Minister.

This NHS arms race between the political parties is a key electoral theme, & as such can be seen as an entertaining parlour game.  Instead of tanks & rocket launchers parading across Red Square, perhaps our political leaders dream of columns of ambulances & paramedics marching along The Mall.  But it does obscure and ignore some of the biggest (actual, real) challenges facing our society, our population’s health and future development.

People working within & outside public services know the issues we face: an ageing population that is living longer but enduring more long term illnesses; significant issues with obesity, diabetes & other limiting conditions; longer working lives & the requirement for skills development, re-training & innovation; the shortage of quality affordable housing, & so on.  From the Marmot Review onwards every analysis of current and future demands on the state has identified the importance the wider, or social, determinants of health & wellbeing.  The importance of prevention, of changes upstream to reduce future impacts of these issues is commonly accepted. The problem is the very people & organisations that have the potential to at least assist in meeting these challenges in the future are currently being slowly strangulated & the focus remains on the last port of call, the already overstretched & buckling Health service. 

None of which is to say that reform & savings are not required across the whole of the public sector.  Most of my colleagues & acquaintances understand the need for change, & believe the days of largesse are deservedly over.  The newer generations entering the public sector workforce are bringing with them a greater emphasis on creativity, problem solving & inventive solutions, unburdened by concerns over tradition, hierarchy & political ideology.  What they require is an environment that provides the freedom to innovate, collaborate & genuinely re form how the public sector might operate, unhindered by ring fences & political groupthink.  The sacred cow of NHS funding illustrates the barriers that remain between the present & future forms of the public sector.

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