Category: Health policy

I must defend the Conservatives: they’re right to set spending against GDP

The Conservative Party has been criticised for claiming that they have halved the deficit, when in monetary terms they have not.  I have to leap to their defence.  The test they have used, treating the deficit as a proportion of GDP,  is entirely legitimate and appropriate.   It sets spending against income, which is how it needs to be seen.   I have used the same indicator myself in this blog.

Let me, however, take the case a little further. The figures in the first two lines come from the OECD and the World Bank.  It’s not surprising that total social expenditure has been cut; but many people will not have realised that, by the test the Conservatives are now applying, spending on health care, which was supposed to be protected, has also suffered.

2009 2010 2011 2012 2013
Social expenditure 23.9% 22.8% 22.7% 23% 22.5%
Health care 9.9% 9.6% 9.4% 9.2%
Benefits and tax credits
– working age and children
6.1% 6.0% 6.0% 6.0% 5.7%
Tax reliefs 18.3% 18.8% 20.5% 21.3%


The third line comes from the DWP.  It’s true that benefits have increased over the years, but that is mainly down to two factors:  pensions, and Tax Credits for the low paid.  If we look only at the DWP benefits for people of working age, which include the ‘out of work benefits’,  another story emerges.  The figures are

1979  2.2%
1984  3.6%
1989  2.7%
1994  4.2%
1999  3.3%
2004 2.8%
2009  3.3%
2014  2.9%

There have been some fluctuations with economic conditions, as we might expect; but the high point was twenty years ago, during the Major government, and the narrative we often hear, of increasing dependency and a relentless increase in costs, is hogwash.

The last line in the table, drawn from a National Audit Office report earlier this year, shows the cost of tax reliefs as a percentage of GDP over the same period.  It helps to make it clear where the government’s priorities lie.

The most direct way to improve health: more money

A new study by the Scottish Public Health Observatory has reviewed the potential effects on health of a series of interventions.  The effects on health are considered mainly in terms of mortality and the need for hospital care.  The measures in relation to incomes, cutting alcohol, tobacco or obesity, and encouraging cycling and walking to work.

Health interventions

The biggest benefits, by far, would be gained by the introduction of a living wage; the next biggest, though it is even more important for the poor, would be an increase in minimum income benefits.  Some of the measures they are being compared to seem restrained – a weight-management service rather than measures to reduce sugar, short-term interventions on alcohol rather than taxation by unit – but the size of the difference is so big that it’s unlikely to  tilt the table.

A pensioner goes walkabout

A report in the Dundee Courier this morning concerns a manhunt (or womanhunt, if you prefer) for an 86-year old  from Dunbartonshire.  When her care workers arrived at 7 am yesterday, she wasn’t there.  A search has been mounted with police dogs, a helicopter and the co-operation of the Ministry of Defence.  It’s not unusual for the police to be involved in searches for missing pensioners – in a case last year in Birmingham, they”searched the local area, made enquiries with relatives and checks with taxi firms, public transport and health care providers” – but the scale of this search raises questions about how we ought to respond.

There is nothing unusual about people with dementia going out.  People with dementia tend to do things that they’ve done throughout their adult life.  It’s often the context that makes the actions seem disturbed  – people going for a walk because they think they’d like to take a walk, cooking in the middle of the night, going to the shops when everything is shut, lighting a fire when they’re cold, deciding to visit their family while not remembering that their family don’t live where they used to.   In the bad old days, which are not that long gone, older people would routinely be incarcerated in psycho-geriatric wards, typically with locked doors.  When we committed ourselves to keeping people in their own homes, we took on a degree of risk.

What kind of response would be proportionate?  I don’t know; I don’t even begin to have an answer.   But there has to be a better way than helicopters and dogs.

The manifesto for mental health

A number of organisations dealing with mental health have issued a ‘manifesto‘, intended to influence policies in the run-up to the 2015 election.  There are several measures I’d endorse wholeheartedly, including better funding, minimum waiting times for access to support services, support for new mothers and improved physical health care for people with mental problems. 

The only point I’m not really convinced by is the idea that there should be “integrated health and employment support to people with mental health conditions who are out of work and seeking employment”.   ‘Integration’ rarely works; when everyone is expected to do everything, things don’t get done properly.   (I asked a nurse recently:  “Are you asked to treat patients holistically?” and she answered, “Oh yes, it’s just that we’ve not been trained to do that bit.”)  We can’t get different parts of the health service to communicate adequately with other parts now, and I’m not sure that adding further services to the brew is going to deliver any more effectively.