Time is running out for voters to wake up to the Tories’ cataclysmic plans

http://www.theguardian.com/commentisfree/2015/feb/19/voters-tories-george-osborne-cuts-nhs-labour

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Ration life! Limit the value of a good year of human life to £13,000 to spend on any one drug, says a report from Prof Karl Claxton of York University. Spend more, and other patients die for lack of funds.

That’s the crunch point in NHS funding, according to health economists at York University, inventors of the original notion of measuring health spending by Qaly – a quality adjusted life year. If all health spending was put through this rigorous analysis of ensuring every pound bought the best value, there would be a remarkable shift in NHS priorities. Mental health would score highest, not lowest, in spending, as each pound can buy the most effective diminution of intense suffering. Suicides are rising, most among young men in deprived areas – deaths that could be preventable at reasonably low cost. Instead, a minor operation may take priority, as headline waiting time targets matter more politically.

During a period of the steepest cuts per capita the NHS has ever known, the government has weakened attempts to ration rationally. Labour set up the National Institute for Health and Care Excellence (Nice) to decide what drugs were good value – fixed at a high £30,000 per Qaly. In opposition, the Tories promised to pay out for super-expensive cancer drugs to prolong a few months of life, after an irrational Daily Mail campaign to keep particular patients going, whatever the cost. Inevitably, Cameron’s cancer drugs fund has burst its budget and left the system in ruins: why cancer? Why not a dozen other treatments? Only because it’s more emotive.

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Every health system on earth is and always will be rationed: the US insurance system runs on a little brown book listing with brutal clarity exactly what can be spent on each condition, cutting people off thereafter: it hasn’t reduced overall costs that are far higher than ours for far less treatment. The cap on the NHS is set by government, but how funds are allocated has always been hidden from view. Hospital consultants have used bully-power to grab what cash and beds they could: psychiatry and unglamorous specialities stood no chance against heroic heart surgery. Rationing was random, mainly by waiting time: you waited until the funds came up for your turn for treatment.

But once Labour’s higher spending brought waiting times down to virtually zero, Nice brought some new transparency to the process, now seriously undermined. York University’s suggestion that £13,000 should be the cap is a useful wake-up call. What if all treatments – or all government spending – were to be put through that economic meat-grinder? Thinking about value for money in the NHS should be a good reminder that it’s badly under-funded and getting worse, with less spent than equivalent countries and worse cuts ahead. Every health thinktank and even the head of NHS England is sounding the alarm: another £8bn is the minimum – but the realistic reckoning is nearer £30bn needed by 2020. One way or another, tax for the NHS needs to rise.

Voters need little reminding of the value they get. I just spent time with a GP whose services cost just £120 per patient per year, less than a Sky TV package. But I also visited a nursing home filled with elderly dementia patients, some violent, needing 24-hour one-to-one care, costing £700 a week. Dare anyone ask what the Qaly value is of that? Total rationality may not be feasible – but the power of Nice to impose priorities should be restored.

The NHS is the easiest tax-raising cause, but rationing faced by all services needs to be spelled out in the face of the gigantic cuts George Osborne set out in his autumn statement. The public has yet to absorb the full impact of what his £50bn cuts would do: a million public sector jobs would go. A survey by the Local Government Information Unit this week found councils “dangerously close to collapse”, unable after April to provide even statutory services. The knock-on effect of half a million fewer frail old people getting social care is already filling NHS beds.

Labour has dithered on running a full-on fear campaign against the Osborne plan. That’s a bad error. The IFS shows Labour plans to reduce the deficit more slowly mean a £5bn cut, 10 times less than the Tories, so why don’t they boast about that and sound the alarm? They fear it adds to the impression that they are not economically credible. But the truly incredible plan is Osborne’s. Unless Labour spells it out loudly, voters risk only waking up to what they voted for when the election is over.

The rational approach to NHS spending advocated by York University should be applied to all government departments, but don’t hold your breath. In the meantime, their calculation on the value of a life comes as a salutary reminder of the critical state of NHS funding, the one service the government dare not let collapse – or not before May.