Editor's Choice

Of intended and unintended consequences

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6060 (Published 27 October 2010) Cite this as: BMJ 2010;341:c6060
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}bmj.com

If you can judge a society by how well it treats its weakest members (the criterion variously credited to Aristotle, Churchill, Dostoevsky, Gandhi, and Pope John Paul II) how will Britain’s Big Society be judged after last week’s comprehensive spending review? (doi:10.1136/bmj.c5952)

Here are some pointers. Welfare spending took the biggest hit: to already announced savings of £11bn (€13bn, $17bn) another £7bn was added, to come “mainly from making working-age benefits for poorer households stingier” (The Economist 2010, 23 Oct, http://bit.ly/bKowOO). “Was it fair that children should emerge as the prime losers?” asks Polly Toynbee in our online debate over the fairness of the cuts (doi:10.1136/bmj.c6053, doi:10.1136/bmj.c6049). In every income group families with school age children lose the highest proportion of their income (6.7%, compared with pensioners losing 2.9% and the childless 2.3%). Women will also lose out disproportionately. “Of the £16bn cut from benefits by the treasury, £11bn is being taken from women’s handbags and only £5bn from men’s wallets,” Toynbee writes. Low earning mothers will lose £1500 worth of childcare credits a year, forcing many on the minimum wage to give up work.

Clare Bambra dissects the government’s changes to incapacity benefits (doi:10.1136/bmj.c6029). Its underlying intention, via various ruses, is “to move all the current 2.6 million recipients of incapacity related benefits on to other benefits.” As she points out, many of the claimants have been out of the labour market and dependent on low value state benefits for a long time: “they did not benefit from the economic boom, but the coalition government seems determined that they will bear the brunt of the bust.”

As several contributors to this week’s journal point out, it will be left to the NHS to try to pick up the pieces. But, as David Hunter warns in his editorial, “Spending cuts affecting welfare, incapacity benefit, working tax credits, childcare funding, housing, and other areas will have a serious negative impact on the NHS and result in growing pressures on services as the fallout from the cuts is felt and the unemployed grow in number” (doi:10.1136/bmj.c6022).

So it’s lucky that the NHS’s budget has been protected from cuts—although as Nick Timmins explains, the real terms annual increase of 0.1% for the next four years turns rapidly into cuts once VAT increases, salary drift, and the diversion of £1bn a year into social care are factored in (doi:10.1136/bmj.c6024). No wonder Sir David Nicholson, the NHS’s chief executive, has been so keen to extract £20bn in efficiency savings from the service over the next few years.

So much for some of the intended consequences of the government’s review. Blame the speed at which it was dreamt up, but its unintended consequences are only now being identified. The public and the media seem remarkably sanguine at the prospect of half a million people losing their public sector jobs (but then in tabloid demonology these people are unproductive drones with overgenerous pensions, one up from benefit cheats). Now Pricewaterhouse Coopers, a professional services firm, has estimated that public sector spending cuts are likely to knock out a similar number of jobs in the lean and mean private sector. What did they do to deserve it?

Abrupt withdrawal of the taxpayers’ teat could also send some charities to the wall, just as they’re meant to take over a big share of public services in the prime minister’s vision of the Big Society. Charities could lose £3bn to £5bn in annual grants as budgets are slashed by local and central government, endangering their very survival (The Financial Times 2010, 25 Oct, http://bit.ly/9QSQjy). Connoisseurs of the law of unintended consequences look like they’re in for a field day.


Cite this as: BMJ 2010;341:c6060


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