Wednesday, June 06, 2007

Bean Counters

Crazy Finances

The Government is expected to announce today that the NHS has made a surplus of more than £500 million in the past financial year after an aggressive drive to reduce spending by health trusts. - The Times

On Sky News this morning:

Eamon, “Can you tell us, is the NHS a service or a business?

Patricia, “It's a service, but actually it must be business-like.”

Why can't we get a real debate about NHS finances? One that focuses on the real issues. One that tells the truth about how the service is financed. A debate that is not led by the bean-counters agenda.

Could someone tell us how the NHS can go from being in debt – to the tune of millions – to having a surplus – all in the space of a few weeks? It's just a nonsense.

The truth is no-one knows what the real financial situation of the NHS is because the bean-counters make the rules, change the rules and (seemingly) change the rules for changing the rules. Only the great British public could be flannelled by such a blatant misuse of power, language and logic.

So, when the media reports about a Primary Health Care Trust being “overspent”, what does that really mean? It means that they have exceeded their budget. Who made the budget? The government. What criteria have the government used to set the budget? No-one knows. Have they tried, as you and I would have to do, to match the income of the NHS to the expenditure? Who knows?

There is no meaningful measurement of NHS income. All the money from National Insurance contributions simply ends up at the Treasury. Only a proportion of this is for the NHS, some should go for unemployment, some for pensions, and so on. What is the exact sum allocated to the NHS in a year – on which a budget could sensibly be based? Who knows?

In the absence of an income statement, there is no NHS budget. Never has been. The NHS budget is simply what the government says it is. Unless the public can understand this the politicians can simply make up numbers. The result? In any one week you get stories about expensive new drugs bankrupting the NHS juxtaposed with the story about NHS budget surpluses.

I confidently predict that the bean-counters will continue to drive the debate. After all, it's in their interest, not ours, for the issues to be presented in budgetary terms. That's their business. They will continue to shift paper clips from one side of the desk to another and publish statistics.

It's sad that the government simply abdicates its responsibilities to the very people they should be holding responsible.

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