I agree that all public services will get worse – but not as bad as they would have got if Gordon and Mandelson were still in charge. They spent all the money, remember?

This was Cameron’s attractive pledge about the NHS made just before the election in May:

“David Cameron has denied that ‘tough’ decisions on spending will mean cuts to frontline health services while campaigning in marginal seats he needs to win to secure overall victory.” [Nursing Times, 4 May 2010]
http://www.nursingtimes.net/whats-new-in-nursing/news-topics/conservative-party/cuts-wont-hit-frontline-nhs-insists-cameron/5014238.article

This was a Telegraph news report on 4 December 2010:

“Across swathes of the country, patients waiting for the most common types of surgery, including hip and knee replacements, and cataract operations, will now be forced to wait months longer for treatment.

“Patients’ groups described the decisions as ‘desperate’, warning that thousands of people, especially the elderly, will be left to suffer in pain this winter as their conditions deteriorate.”
http://www.telegraph.co.uk/health/healthnews/8181390/Patients-denied-hip-surgery-and-fertility-treatment-amid-NHS-cash-crisis.html

And this was a news report from 17 December:

“Hundreds of thousands of NHS patients are being denied routine procedures as dozens of trusts cut back on surgery, scans and other treatments in order to save money, a Daily Telegraph investigation has found.”
http://www.telegraph.co.uk/health/healthnews/8208958/Patients-denied-treatment-as-NHS-makes-cutbacks-Telegraph-can-disclose.html

but not as bad as they would have got if Gordon and Mandelson were still in charge.

Most objective measures of public services show outcomes improved massively under Labour, thanks to investment that the Thatcher govt never made. Sure, there was waste too – but I don’t see how this can be completely eliminated.

If by the same measures outcomes in public services fall in a few years (and some evidence suggests they have already, in NHS waiting times) – then Tories will lose out.

@1. Dioclese

I agree that all public services will get worse – but not as bad as they would have got if Gordon and Mandelson were still in charge. They spent all the money, remember?

Umm, no. The pre-election budget forecasts were too pessimistic, and after the election it was shown that we had to borrow less. The money had not all gone, and Osborne was able to conjure up £7bn to bail out the Irish, remember?

However, last month (November) the Conservative government borrowed record amounts. Things are getting worse. And next year, with the VAT rise and tax rises, and the cuts in public sector jobs once the spending review cuts start, it will get worse. Very, very worse.

But it is not just policy that is the problem. It is a matter of competence.

Gove is performing so many U-turns that he has to go around on roller blades. Lansley is proving completely incompetent at getting basic public health right, and his level of financial control is abysmal. The consequence is that people will die unnecessarily from swine flu this winter, when simple and cheap public health publicity would have persuaded them to get the flu jab. The NHS is going into financial meltdown – Prof Bosenquet, a respected health economist at Imperial College says that there will be a financial crisis in November 2011. This will be in an unprecedented scale. Lansley has ample warning, but he’s still arrogantly moving ahead with the expensive re-organisation that was never needed and will mean that the NHS will not be able to manage the financial crisis.

Make sure you don’t get ill next year – it will be the worst year ever for the NHS and its patients.

Those, Tory voters or otherwise, who believe things will become worse may well still be devout believers in the ‘there is no alternative’ mantra – that’s in part what many of them voted for and remains the mad delusion which needs to be shattered

@5: “that’s in part what many of them voted for and remains the mad delusion which needs to be shattered”

Try this in the news today about the foreseeable consequences of the staffing cuts underway in the NHS:

“There was ‘indisputable evidence’ linking patient mortality rates to staffing levels, Mr Carter said, citing a study that identified a 26% increase in survival rates in hospitals with the highest patient-to-nurse ratios.

“‘More than half of nurses have already told us they are too busy to provide the standard of care they would like.

“‘When they are seeing further cutbacks, less shift cover, more patients to attend to, they will have less time to give each patient and there is no doubt care will suffer.'”
http://www.bbc.co.uk/news/health-12080056

Almost needless to say, elderly patients will be the most vulnerable as the result of NHS staffing cuts but then this was the verdict of the Telegraph on Osborne’s “emergency” budget in June:

Pensioners came out as one of its biggest losers in George Osborne’s emergency Budget.
http://www.telegraph.co.uk/finance/personalfinance/how-budget-affect-me/7847875/Budget-2010-Pensioners-are-the-biggest-losers.html

“If by the same measures outcomes in public services fall in a few years”

As part of the cost cutting, they’ll scrap the collection and publication of statistics.

Well every one who voted for change, as the Tory election mantra said, got just that.

A change from being employed
A change in higher prices
A change in child benefit cuts
A change in crime rates – rising fast due to police, courts & prison cuts
A change in or education system becoming so underfunded
A change in David Cameron going from “you cacb trust me not to cut” to hiding behind his incompetent cabinet ministers.

I hope all the Tory voters & supporters (like the Sun whose readership will be hardest hit) are happy.

I think we can all agree that the government’s decision to pick on pensioners was a shrewd political calculation.

Pensioners as a group aren’t especially political active, even in propitious circumstances, and many pensioners will fall victim to the inevitable ailments and fate of the elderly before the next election. If the mortality rate of pensioners happens to rise as a consequence of those cuts in the NHS that brings an additional fiscal bonus – a lower payout from the exchequer for state penions.

Simon H @8

Excellent and perceptive list – could add more – the Tories never change. However, Simon H – you hope – (regarding those benighted ones who voted Tory ‘for change’) “are happy.”
Well the sober and sickening truth is that there are voters who ARE happy – who voted knowing full well that the Tories would cut and cut and cut – and are happy that the cuts have fallen where they have – on the ever-hapless vulnerable in society. Furthermore these happy Tory Scrooges and VAT raisers will vote the same way next time! Britain is in the perma-frost grip of ‘change’ which is really Tory no-change and no hope.

@10

Trouble is for many the cuts haven’t hit their family/household yet. By Feb/march mist will have had reality of this ideological cut program.

What will they do when they’re paying out more in jsa than they’re getting in taxes?

Depends what you mean by ‘worse’. I suspect they’ll drop on the government target measures because the government isn’t holding them to those targets anymore, so no need to fudge figures to make themselves appear better (which everyone does, it’s only natural in a target driven environment to adjust the numbers to get the best score you can).

Whether that means actually worse service I guess remains to be seen.

@11

Cut JSA. Which they are already doing by changing the uprating measure. & penalising the unemployed for the audacity of not finding a job by cutting their benefits by X after Y months (see: housing benefit to be cut after 12 months on the dole).

Could be worse I suppose, we could still have a Liebour government in power sticking it’s head in the ground and telling people there is no crisis.

re:the link between patient mortality rates and staffing levels

How best can this link be characterised?

Is it that for every extra equally well-trained and motivated member of staff there is an equal improvement in health ad infinitum, or is it a case where the law of diminishing returns can be applied?

If the later, at what point can extra health spending become better spent elsewhere?

Example time.

If you had to choose hypothetically between the winter fuel payment and advertising for the winter flu jab, which has greater benefit with regards to lives saved for the same cost?

Answering my own hypothetical, I’d choose to cut back on the advertising, as this is secondary to having the service in the first place.

However, it may be better to ask how much the advertising contracts were worth and ask for evidence of the level of value for money they provide.

The left are arguing for economic growth, so it’s perverse to then seek to support economic areas which are less productive.

“The left are arguing for economic growth, so it’s perverse to then seek to support economic areas which are less productive.”

Which could, of course, account for why the government is hitting on hapless pensioners.

@Bob B
Really, pensioners – hapless?

Pensioners are the section of society most likely to vote, they have the largest accumulated savings and are the group which profited most from the years of baby-booming profligacy, who elected the terrible governments of recent decades and decided the direction of policy which their children and grandchildren are being left to pick up the tab on.

Current pensioners may also be the first generation to live longer than their decendents.

If they can’t or shouldn’t pay any fair share then I certainly won’t.

Frankly I find it insulting that the accumulated knowledge and experience accrued by our senior citzens can be dismissed quite as easily as you are prepared to claim.

Did they go through their lives as innocent bystanders in the political debates of the times? Are over 60/65s not equally responsible for the circumstances we find ourselves in? Was Prezza not making decisions at the highest level in the most recent government?

If you want fairness you’re just gonna have to accept everybody must participate ‘according to their means’.

Or are you just pandering politically for partisan gain?

Give pensioners their due, certainly, but don’t pretend it’ll all be silk and roses.

I can agree that specific policy details will likely cause disproportionate discomfort, but that’s the blunt instruments of government working for readjustment.

And if you can’t be sharper in your critique of government policy then you can’t hope to pinpoint potential improvements – you’re not engaging with the terms of debate.

Unilateral opposition to all the coalition’s cuts will mark you out as an irrelevant ideologue and you will be defeated at every election from here to kingdom come – it’s a trap set for Labour which Ed Miliband is already starting to fall into in the absence of any real intellectual grounds for opposition.

So if you don’t want to be sat on the sidelines for a whole generation or longer you might like to wipe the romantic mists of your childhood from your mind and stop dreaming of refighting the lost battles of decades past.

@17: “And if you can’t be sharper in your critique of government policy then you can’t hope to pinpoint potential improvements – you’re not engaging with the terms of debate.”

C’mon. In the run-up to the election in May, Cameron specifically pledged to protect frontline NHS healthcare services but news reports in December show frontline NHS healthservices are being cut back – see the links @2 and @6.

People of around pensionable age are especially vulnerable to the reported cuts in NHS frontline services: “patients waiting for the most common types of surgery, including hip and knee replacements, and cataract operations, will now be forced to wait months longer for treatment.”

And it’s not as though the elderly were already receiving good treatment from the NHS – they are not:

“Hospitals must improve their care of elderly patients undergoing surgery, an independent review has concluded.

“Pain management, nutrition and delays were all highlighted as problems by experts from the National Confidential Enquiry into Patient Outcome and Death.

“Overall, just over a third of patients were judged to have had good treatment.”
http://www.bbc.co.uk/news/health-11728163

It was the Telegraph which pointed out that pensioners are “the biggest losers” from Osborne’s budget in June.

As for pensioners being the most likely to vote, Cameron’s broken pledges aren’t much of an advertisement for the coalition. Spin and sophistry won’t cover-up the harsh reality.

The long term implications of this are significant. A sense of degredation of public services is a powerful influence on the public. It just isn’t a rapid one.

It takes time before people feel like things are getting worse, even if they see lots of stats showing things get worse quickly.

So Labour need to be ready with an alternative plan. They need to be opposing specific measures by proposing something else.

That is crucial – because otherwise the sense of degredation becomes a complacent view that public services always get worse and no one can do anything about that.

Tony Blair blew appart that sense of innevitability in the mid 90s.

It will need to be countered again.

@Bob B
I don’t see your sources back up your conclusion.

You seem to start with the assertion that frontline services are being cut, then you say service levels are not as high as desired and then take a politically charged quote as confirmation of your preconcieved notion.

Longer waits for operations does not necessarily mean a cutback and could have many different causes, such as higher volumes. And neither is the quality of service completely dependant on funding.

With any administrative shake-up such as is occurring one would expect a transitional phase (and some declines in standards) even when funding levels increases. Exactly this happened during the late 90s and pressure built as a result to show the gains made.

Today reforms are being introduced without similar increases in spending, and they haven’t yet been properly communicated, so it’s only natural there will be negative sounds. But until we learn the full details and they filter through into full practise it’s impossible to make a fair and balanced judgement.

I’m by no means a defender of the coalition, but if opponents of it make misplaced arguments then it only strengthens their position once the initial shock of the treatment subsides.

So this is nothing more than an attempt to set the tone of the narrative by making perception triumph over as-yet unknown fact.

Since when were reliable commentators ruled by fear?

The NHS does need reform, in particular by reducing excessive bureaucracy and certralised targets and the mass of high-earning managers who’ve proliferated in recent years together with corporate incentives for more expensive treatments as the first option.

The coalition has set themselves a big challenge to make the systems more effective in delicering service improvements and its far from certain they will be successful, but it won’t help matters if it is done in a spirit of confrontation.

I fully accept the change in philosophy requires adjustment, but health is an acknowledged money pit – eventually you have to stop throwing more and more money at the same problems.

Like my doctor tells me – prevention is always better than a cure, and it’ll usually be cheaper in the long run too.

@20: “Longer waits for operations does not necessarily mean a cutback and could have many different causes, such as higher volumes. And neither is the quality of service completely dependant on funding.”

I suggest you tell that to the patients – as reported in two news reports in the Telegraph – who have had scheduled NHS operations postponed again – like my friend who had her scheduled cataract operation postponed to March next year and then to May. She went private at that stage because she is of an age when her driving licence has to be renewed. And if readers reflect on the operations mentioned in those recent Telegraph news reports linked @2, those operations are most likely to relate to patients of around pensionable age, like myself. As someone who has just had one of those operations, I guess I was fortunate in just getting in before the shutters came down – at least I’m not now taking a continuing series of painkiller pills everyday, which I was.

My local hospital trust has been told to make £30 million in cost savings – it made the news because the chief executive suggested that staff could consider giving up a day’s holiday entitlement to reduce the scale of staff redundancies or other painful options.

IMO an awful amount of effort is being put into spin to cover-up the reality.

@ 3:

“Most objective measures of public services show outcomes improved massively under Labour, thanks to investment that the Thatcher govt never made.”

Firstly, what are these “objective measures” measuring? Bear in mind that at least some of the improvement may be due to services being geared towards fulfilling the criteria being measured, whilst actually offering worse service to the general public.

Secondly, if you’re going to throw vast amounts of money at a problem, it’s no wonder that some of the money will end up improving services. The problem is that a lot of the extra spending hasn’t gone towards funding front-line services, and that this waste spending has been so high over recent years that the country can no longer afford to keep spending at its current levels.

“Sure, there was waste too – but I don’t see how this can be completely eliminated.”

The fact that waste can never be completely eliminated is no reason not to try, any more than the fact that racism can never be completely eliminated means that we shouldn’t bother criticising racist opinions.

“Are Tories losing opinion on public services?”

Maybe, but didn’t everyone predict that the government would suffer an initial drop in popularity as they started cutting/the left started throwing around apocalyptic warnings of what the cuts would result in? The more important question is “What will public opinion regarding Her Majesty’s Government be in five years’ time?”

By several accounts, in five years time we will be depending on charitable donations made through cash dispensing machines at the banks for social and healthcare services:
http://www.guardian.co.uk/commentisfree/2010/dec/31/francis-maude-big-society-charity

I wonder who or what will get to choose which charities will be posted up there on the machines waiting to attract donations through this arrangement?

For a while, “transparency” and “accountability” became important features of the public services.

Questions could be – and were – asked in Parliament about the performance of individual Primamry Care Trusts in the NHS. The salaries of public officials are posted – although they could take a bit of delving. HoC slect committees or the National Audit Office would rake over and assess the value of public spending on welfare services. But will it be possible for MPs to ask questions on Parliament about the performance of particular charities? How easy will it be to find out how much of the cash donated to charities disappears into the costs of “administration” without ever getting to the frontline?

I’ll be more convinced about the public benefits of funding social and health care services when the salaries of MPs and councillors’ allowances are funded through charitable donations. Fat chance.

How long did it take us to learn this startling fact?

More than half of MPs have been found guilty of over-claiming on their parliamentary expenses.
http://www.telegraph.co.uk/news/newstopics/mps-expenses/7161198/More-than-half-of-MPs-guilty-of-over-claiming-expenses.html