Osborne’s public health cut is a blunder too far

http://www.theguardian.com/society/2015/sep/02/public-health-cut-osborne-nhs

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In their entertaining and instructive book The Blunders of Our Governments, Anthony King and Ivor Crewe argue that our elected leaders “screw up more often than most people seem to realise”. For all its unexpected overall majority and smooth ride, courtesy of the opposition’s disarray, the Cameron administration is proving no exception.

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King and Crewe make an important distinction, however. While all blunders are mistakes, they say, not all mistakes are blunders. Many mistakes are simple judgment calls: “they will sometimes be right and sometimes wrong, but the fact that they turn out to have been wrong on a particular occasion does not necessarily mean that they have blundered”.

Reflecting on the government’s first four months, you can identify several decisions that already look like mistakes. The announcement in the July budget that the public sector pay bill would be limited to 1% annual rises for another four years immediately felt like storing up trouble, but Greg Hands, chief secretary to the Treasury, has now compounded things by telling the pay review bodies that “some workers could receive more than 1% while others could receive less; there should be no expectation that every worker will receive a 1% award”. Average earnings across all sectors are rising by 3.2%.

Similarly, the decision to “pause” electrification of the TransPennine rail route between Manchester and Leeds, as well as the Midland mainline from Sheffield to London, seems a mistake that has done incalculable damage to the fabled “northern powerhouse” plan – if only because of the message it has sent about priorities, with electrification of the Bristol-London line remaining very much on course.

As local government bodies have said, the cut is 'short-sighted, short-term and unwarranted'

But if it’s real blunder potential you’re looking for, consider the move to cut this year’s public health budgets in England by £200m. It’s not the stuff of headlines – it was barely noticed by the non-specialist media when chancellor George Osborne casually announced it, ahead of his budget, as an “in-year-saving” on “non-NHS” spending– and £200m seems small beer against the £70bn deficit that Osborne aims to clear by the end of this parliament. But the effect is profound.

As the autumn conference season gets off to an unusually early start this week, with ministers and top officials addressing the Health and Care Innovation Expo in Manchester, there is palpable anxiety around the health and social care sector. The debt-laden NHS is starting to absorb the fact that health secretary Jeremy Hunt may actually mean it when he says there will be no more money this winter, while leading care home chains are said by the very councils that fund them to be “teetering on the edge of financial meltdown”.

Give or take an expected emergency bung for social care in the November comprehensive spending review, there are broadly two games in town: one is the ambitious Five Year Forward View blueprint drawn up by NHS England chief executive Simon Stevens, designed to make the health service sustainable by 2020; the other is the £5.3bn Better Care Fund (BCF), aiming to drive integration of health and care commissioning and services. The £200m public health cut undermines both.

Stevens’s plan talks of a “radical upgrade in prevention and public health” to ease the burden of disease. Yet the 6.2% cut in councils’ public health budgets will hit programmes that counter obesity and smoking, drug and alcohol misuse and sexually transmitted infections. As local government bodies have said, the cut is “short-sighted, short-term and unwarranted”.

The BCF, meanwhile, needs all the support it can get. It is currently seeking its third director this year and to say there is a degree of scepticism about it, especially on the NHS side of the equation, would be putting it mildly. Health chiefs already nervous of putting their cash into a joint kitty to fund integration have now seen ministers grab back £200m that would have been “protected” NHS money had responsibility for public health not been transferred to local government in 2013.

If the BCF flops, and if Stevens fails, there’s no plan B for the health and care system as we know it. Osborne’s pilfering of public health cash certainly looks like a silly mistake – and could turn out to be a very serious blunder indeed.