Andrew Lansley is to prevent primary care trusts from arbitrarily setting minimum waiting times and caps on the number of NHS treatments. In principle quite right too.
But the NHS also still has maximum waiting times – despite the health secretary’s initial attempt to scrap them as a Labour “top down” target.
So cash pressured primary care trusts, and their successors the clinical commissioning groups, will not be allowed to set minimum waits but will still have to attempt to honour maximum ones when longer waits have always been the way the service copes when spending is tight.
Over the next four years it is set to get very tight indeed as demand rises but the money remains flat in real terms.
So how can it cope? The good ways include redesigning service to deliver high quality at lower cost – in effect increasing efficiency – although the service’s ability to do that on the scale needed is in question. The bad ones are likely to include raising the threshold for treatment – requiring more pain and disability before patients are referred.
Either way, solving the equation of keeping waits short while balancing the books will be tough. So the gap between today’s rhetoric of “unacceptable” minimum waits and the reality on the ground may become large.
Health – which unlike other government departments is not facing actual cuts – is far from alone in this.
The current row over the Border Agency is an early and acute example of the impact of spending cuts that produce a gap between promises and reality – ministers may promise tight immigration controls but there are fewer staff now, and will be many fewer in future, to deliver that.
Iain Duncan Smith wants a vastly more intrusive relationship between the state and people in work who claim help with child care and housing costs – pushing them to work longer and threatening sanctions if they do not try.
But amid huge cuts in the work department’s administrative budget, where will the staff be found to implement that in practice? As the spending cuts bite, the distance between what minister’s say they want the state to deliver, and what it in practice it can, may well grow.