NHS costs: A political hot potato

There is a debate we are not having on the NHS.

In private, senior NHS figures say the service will go bust unless we spend money differently – keeping people well, rather than just treating us when we are ill. The growing cost of new technology, medicines and population ageing can only be afforded, they say, if we are better at spending NHS money.

None of the main political parties are touching this: Labour because it’s trying to repair the damage done by the efficiency drive imposed by Patricia Hewitt; the Conservatives because they want to show the NHS is safe in their hands.

You can see the logic, however. For asthma care, we spend an awful lot on emergency hospital admissions and a lot less on self management, care planning or primary care. Of course, there will always be a need for hospitals. But we know that 75% of hospital admissions could have been prevented, with earlier interventions, better care management and the use of tools like Personal Asthma Action Plans.

Professor Paul Corrigan, a former adviser to Alan Milburn and until recently chief strategist for the NHS in London, has argued that spending on long-term conditions like asthma should be directed by commissioners away from hospitals and into self management and care at home. Better management of costs – mainly emergency admissions and drugs – would free up resources for more nurses and extra support, perhaps over the telephone, so we are less reliant on having to visit inconvenient GP practices.

It’s an interesting argument and one I suspect we will hear more of in coming months. The credit crunch has not yet hit the public sector but when it does we will need to work hard at getting better results from fewer resources. If we don’t, we really will see a reduction in core services.

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