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Tories reveal plans for reducing NHS costs and funding residential care for elderly people

BMJ 2009; 339 doi: (Published 07 October 2009) Cite this as: BMJ 2009;339:b4131
  1. Oliver Ellis
  1. 1BMJ

    The Conservatives’ shadow health secretary, Andrew Lansley, has pledged to cut NHS administration costs by £1.5bn (€1.6bn; $2.4bn) in the next four years.

    Speaking at the party’s conference in Manchester this week, Mr Lansley promised to reduce spending on health service bureaucracy, which he estimated at £4.5bn. He said that primary care trusts, strategic health authorities, health “quangos,” and the Department of Health would all face cuts, with savings being passed on to frontline services.

    Mr Lansley committed a future Conservative government to improving patients’ choice, abolishing political targets, and transferring power “out from the centre, into the hands of health professionals and patients.”

    “Top-down command and control must go,” he said. “It is a gross insult to doctors and nurses to say that without the targets they would let patients wait and suffer. It is increasing capacity which delivered reduced waiting times. If we build capacity, and patients use their choice to drive the access they want, we will see waiting times fall and standards rise.”

    Mr Lansley also announced plans for a new, insurance based model for social care, to prevent people having to sell their homes to fund residential care. It would involve people paying a one-off sum of around £8000 at the age 65, which would go into a communal fund to pay for residential care.

    Niall Dickson, chief executive of the healthcare think tank the King’s Fund, welcomed the news that the Conservatives were looking to make savings that would not affect frontline care, but he warned that the savings would not be enough to fund the NHS’s future needs.

    “Whichever party forms the next government will have to address how clinical care can be delivered for less, without affecting quality or equity,” he said.

    Mr Dickson also urged caution in scrapping targets. “Health care is a complex business, and it needs to be well managed. We must not fall into the trap of thinking that all clinicians are good and all managers are bad—that would be both simplistic and harmful.

    “If we are to devolve power and responsibility from the centre, we will need good arrangements for regulation and monitoring to ensure that patients are protected and high quality is maintained.

    “Andrew Lansley is right to call for a focus on outcomes, but it would be a mistake to imply that targets have done more harm than good. All well run organisations have targets, and there is evidence that NHS targets have worked to improve services in ways that are important to patients—like reducing waiting times.”

    In response to Mr Lansley’s speech a BMA spokesman said: “While central targets may have brought about improvements to patient care, in some cases they have also been prioritised over the needs of individual patients. However the success of the NHS is measured in future, there should be engagement with doctors and nurses and local flexibility.

    “The crucial thing is that frontline services are safeguarded. Patients should not be penalised because of the financial pressures facing the NHS.”


    Cite this as: BMJ 2009;339:b4131

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