That NHS spending row in full

The story: Conservative Health secretary Jeremy Hunt ‘rebuked’ for claiming the Coalition has increased NHS spending in England.

The promise: that the NHS budget in England would be increased in real terms during the Coalition. That promise was kept (just) — the 2010 Spending Review committed the Coalition to a 0.1% real-terms annual increase.

The reality: the NHS did not spend all its budget in 2011/12. As a result, the out-turn in NHS spending has, probably, marginally fallen since 2009/10. Though the UK Statistics Authority concludes: “Given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real terms expenditure had changed little over this period.”

The analogy: If you get a pay increase but don’t spend it all, would you be right to argue that your employers had cut your pay?

The context: Spending on the NHS in England is planned by the Coalition to be higher throughout this Parliament than it was in any year under Labour.

The sting in the tail: Just because the Coalition is increasing the NHS budget in real-terms doesn’t mean there aren’t big, looming problems in the affordability of health-care, as the IFS has highlighted, especially if the Dlnot reforms of social care are implemented in full or in part.

* Stephen was Editor (and Co-Editor) of Liberal Democrat Voice from 2007 to 2015, and writes at The Collected Stephen Tall.

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  • Why arent Labour attacking the NHS middle-management for not spending their budget quickly enough? Oh, yes, because that wouldnt look good.

  • I am afraid the Liberal Democrats showed their true colours re. the NHS when the Health Bill was before parliament. Befor the 2010 general they had promised no big re-organisation of the health service (like all the other parties), but when Lansley’s plans surfaced, the LibDems suddenly become enthusiastic supporters of the Bill. Mr Clegg and Shriley Williams, in particular, agreed with a massive Tory re-organisation and commercialisation of the NHS (no I am not exagerating). Such is the LibDems’ commitment to the National Health Service. I believe this has angered a big proportion of the electorate.

  • Certainly it is true that there are big, looming problems in the affordability of health care but equally it true that life is meaningless, even a burden, without good health. So let’s get our priorities right and fund health care effectively. The easy answer is to throw more money into the NHS but this will solve nothing and anger taxpayers if it goes into increased bureaucracy and wasteful practices. However more money has to be found and I believe it can be done through taxation if there is greater transparency that can convince the public that there is a purge on bureaucracy and waste and that their money is being l spent well and in the right places. After all people may moan about increased premiums but they still insure their homes, their cars and their possessions against unforeseen accidents so what is the difference and why should reasonable people object if they see their contributions to National Insurance (more so if ring-fenced) as a premium that covers them against the uncertainties of life itself?

  • “Befor the 2010 general they had promised no big re-organisation of the health service (like all the other parties)”

    Where did we say that? We wanted to replace PCTs with elected local Health Boards which is a pretty major re-organisation.

  • “Where did we say that?”

    It was actually in the coalition agreement, of course – just after the general election.

  • Peter Andrews 5th Dec '12 - 5:53pm

    It may have been in the coalition agreement but Lib Dems did NOT say it before the election the Tories did.

  • @Hywel. Just to set the record straight.

    Before the 2010 general election the Liberal Democrats promised no big re-organisation of the National Health Service. Not only was there no mention of a “massiver reorganisation” of the NHS, but there was total silence about the huge commercialisaton of it – with which the LIbDems were hand-in-glove with Lansley’s plans. As we speak (so to speak) private companies are queuing up to get a slice of the action. BUT, as I said none of the LibDem/Tory Health Act was approved by the British electorate. From what I hear in everyday conversation I also believe that many voters regard that Act to have been an expression of malice (of State provision) rather than of benevolence towards the NHS. LibDems take note. In 2010 voters weren’t given the opportunity to ‘veto’ the Tories health agenda (isasmuch as the Tory party did not tell what they planned). But make no mistake, in 2015 the voters will well and truly have their say!

  • @Mike C. I entirely agree that efficiency is incredibly important, and therefore the pursuit efficient practise must be a goal in the NHS as in any other large organisation. So why the Health Act? How does contracting-out services lead to efficiency? I have personal experience of contracted-out services and without exception it lead to corners being cut, lower standards and a poorer all-round job being done. Of course the work was done ‘cheaper’ in all the senses of the word. I am at a loss as to why the LibDems ended up supporting Tories’ Health Bill. It will be the LibDems who will be on the recieving end of voters’ wrath (in my opinion).

  • Dave – where did we say that? It isn’t consistent with what was in our manifesto.

    It was said in the coalition agreement – that seemed sensible because us and the Tories had very differing ideas about NHS reform and the NHS bill is a bad piece of legislation (on which I agree with your conclusions).

    However we did not go into the election pledging no big reorgansiation of the NHS as we’ve always been in favour of fairly big reorgansiations (not least because it is horribly centralised).

  • Tony Dawson 5th Dec '12 - 8:03pm


    ” Not only was there no mention of a “massiver reorganisation” of the NHS, but there was total silence about the huge commercialisaton of it ”

    Sorry, Big Dave, it was the previous Labour government which FORCED NHS Trusts to privatise services. Including making substantial payments to some ‘providers’ which didn’t do a thing: they were paid for making a ‘commitment’ to provide, whether their involvement was needed or not..

  • @Tony Dawson. I am not defending Labour for their NHS ‘pivatisation’. I will, however, give them some credit for pumping huge amouts of money into the NHS – and in general terms this worked. By 2010 patient satisfaction was historically the highest ever (it’s on the slide now though!). But I certainly do not speak for the Labour Party. What I would really, really like to hear from at least one LibDem contributor here is a sensible, well-argued and heartfelt defence of the LibDems’ support for the Health Act. I would like to know, from a LibDem perspective, the benefits be gained for NHS patients and staff. I would like the LibDems to tell me why the NHS will be that much better afterthe Act than it was before the Act. Because I have never heard a loud and clear endorsement of Lansley’s Act from ANY LibDem. If, as a Party you supported the then Bill in Parliament, why are you not prepared to defend the now Act verbally?

  • The analogy: If you get a pay increase but don’t spend it all, would you be right to argue that your employers had cut your pay?”

    No, but that’s a bit straw-man isn’t it? The correct analogy would involve your employers taking back the part of your pay you didn’t spend. That would seem like a pay cut to me.

  • “It’s completely false to say the Liberal Democrats became enthusiastic supporters of the bill. We forced amendments in it and then reluctantly went along with it on the basis that in a coalition you have to make compromises, and that means winning some, losing some.”

    It’s astonishing how people are trying to rewrite history, even after such a short space of time.

    The simple fact is that this wasn’t in the coalition agreement, so the party didn’t need to go along with a word of it. Nevertheless, it voluntarily agreed to the whole thing within months of the election. It was only later that the leadership got cold feet, but by then it was too late to do more than modify it.

  • @Simon Banks
    There was some pretty enthusiastic support on this site, not least in the threads by Paul Burstow, even before the changes. Also if the party wants to cling to any visage of democracy once the coalition agreement had been voted on and accepted, no large scale reorganisation should have been nodded through whatever the changes (which in my view never went far enough especially in professional training).

    While there may be much rhetoric in what Big Dave has said there is no room for crowing on the NHS, many trusts probably came under budget as they had recruitment freezes and other cuts in place at harm patient outcomes and care. Labour did some atrocious things in power but the service improved over the course of their years ( in spite of not because of many of their changes). I work in health care as does my wife and a great many of our friends. The ones within the NHS are pretty much united in their opposition to the Bill, and moral is a large and growing problem.

  • @Simon Banks. You seriously underestimate the electorate by inferring that they may be “swallowing Labour propaganda”. I believe the electorate are more than capable of making up their own minds on these matters. As for the ‘Helath Bill’ and the LibDems; there are two very important facts that have been identified on this site frequently: (1) The Coalition Agreement did not include Mr Lansley’s Health Bill, in no respect were the LibDems required to be involved with it at all, and (2) Mr Clegg agreed to allow the original ‘Lansley Bill’ a ‘safe passage’ with no LibDem revisions at all; until, as they say in the USA, some of his party began to “smell the coffee”. Also I am bound to ask you this; if a parliamentary Bill (now Act) has some “very bad stuff” in it, does it not deserve to be voted down? Any “good stuff” is surely of no consequence. Some things are not negotiable.

  • John Broggio 6th Dec '12 - 7:32pm

    @Simon Banks

    “It’s completely false to say the Liberal Democrats became enthusiastic supporters of the bill.”

    Really? From “Ahead of the debate, Conservative and Lib Dem ministers “banged” the table at a cabinet meeting to mark the impending passing of the NHS reforms into law.” No, not at all enthusiastic.

  • Let us be honest: the behaviour of the Liberal Democrats re. the Health Bill is totally indefensible. – that is not to say that I support Labour or the Tories.

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