Just how much can you get from a pint pot?

Never in the history of the NHS has a parliamentary Bill met with the level of opposition that has confronted the Lansley Health and Social Care Bill. What Lansley lacks in drafting skills he makes up for with tenacity and nobody would be surprised to learn that he is now fighting a rearguard action to drive through the changes he and his henchman have decided are necessary. Now you might think that Grumble is a bit antagonistic towards Mr Lansley. And you would be right. But Grumble is a fair man and he likes to look at the evidence and, if there is no evidence, the arguments. So it was with interest that Grumble read Lansley's recent article in the Telegraph. Unsurprisingly there is quite a lot wrong with it.

Now if Grumble were to write an article on the NHS he would start with a little homily about the wonders of the health service. It is the obvious way to start but we don't get this from the Secretary of State. Oh no. Quite the opposite. He sees the NHS not as something to be valued and cherished but a burdensome yoke. Keeping it going as it is will inevtiably lead to a 'crisis tomorrow'. What is his evidence? It is that there are 'enormous financial pressures looming on the horizon'. You have heard it all before. This is the 'something must be done' argument which politicians use to justify almost anything that they want to change - especially when they have no better argument for change.

Now nobody doubts that there is going to be a crisis ahead as far as funding the NHS is concerned. But this is not to do with the NHS itself. This is a problem which is going to face every modern healthcare system in the world. There are various reasons for this. Lansley enumerates them - one of the few things he has got right.

Another thing that Lansley probably has got right is the funding gap. He tells us that by 2015 the health service will need £130 billion per year and that this leaves a funding gap of £20 billion. OK. Dr Grumble believes him. Something does have to be done to deal with this. But what is his solution to this problem? The answer it seems is that the NHS is going to have to work smarter. Then, in the same breath, he trots out the already discredited but now standard political tale of the poor cancer performance of the NHS and the equally discredited heart disease figures. What has this to do with saving money? If he is right and we are doing so badly, this is going to need more money not less. This is not just about 'working smarter'. And, in any case, if you save people from these diseases they live longer to die of something else and that ends up costing the NHS more not less. It is actually the success of the NHS with rapidly increasing numbers of elderly that has caused the impending healthcare spending crisis. It is not the poor performance of the NHS that is responsible for the looming crisis, it is the opposite.

Then he trots out the oft repeated mantra of 'no decision about me without me' and 'patient empowerment'. Laudable though these may be, how can patient empowerment possibly fill the funding gap?

So now Grumble is really left wondering about what the Lansley Bill is really about because saving money through improved efficiency does not seem to be it. Empowering the patient and chopping up the NHS into multiple providers each competing with each other is hardly likely to save money. The reason why there are now so many managers in the NHS is because of the preparation for privatisation. Running a market inevitably wastes money. It requires managers to commission services and it requires regulation. What is even worse is that organisations which get paid per item of work will, surprise, surprise, do more work. That might be good for waiting lists but it is not good if you want to save money. Saving money is about minimising healthcare and, believe it or not, you probably can do that without necessarily damaging the quality of care. That is smarter working but you won't get that from a market that pays you more if you do more work.

What is this Bill really about? How is Lansley going to make up the £20 billion shortfall when the new NHS he is creating will be less and not more efficient? There can be only one answer. This is the beginning of the winding down of the NHS. Patients will somehow be persuaded that they need to pay for some of their healthcare themselves. That is where 'empowering the patient' comes in. What other explanation can there be?

Oh, one more thing Grumble nearly forgot. Messrs Lansley and Cameron like to compare healthcare in France with healthcare in the UK to demonstrate how rotten the NHS is. It's doubtful if the figures they give you are at all reliable but one thing they always fail to tell you is that in France they spend 29% more on their healthcare than we spend on the NHS. If we did the same we wouldn't have a funding shortfall. We would be in credit.

Mr Lansley is never going to get a quart out of a pint pot and he knows it. The real intent is in the title of the Lansley article: "Why the health service needs surgery". Notice the NHS doesn't need medicine, it needs surgery. And we all know what that means. Surgery involves cutting and Dr Grumble is suspicious that the Lansley Bill will ultimately lead to exactly that: cuts.