Editorial Monday 14 July 2014: A modest proposal on NHS and public sector funding

'Pecs Dance' Poulter, on top of The Buttle Of Britain's response to the Nuffield Trust's funding report, offers perhaps the clearest confirmation yet that we are near to an explicit moment of shit-fan interfacing.

It's not particularly tricky to understand the root cause. The NHS has been asked to do more, safer and higher-quality care (which raises costs) while receiving slightly above flat real funding for the past four financial years.

The waiting list has ambulance waits are rising and more will follow. Problems always show up in and around A&E.

(We've already seen a big U-turn on the Pothole Care Fund, with acute providers likely to receive cash when demand is not diverted, which it won't be.)

More squirts of cash will also follow, sure as night follows day. These (ranging from the Electoral Resilience Fund to the Prime Minister's Panic Fund and the Pothole Care Fund) may help tinker at the margins, but what we need is a game-changer.

Thank goodness, then, for this best government since the last one. They have come up with a proposal of radical brilliance, to disgraceful briefing to the Telegraph this weekend on Tory plans to force jobseekers to receive mental health treatment is another parp on the dogwhistle siren for the right-of-wing and hard-of-thought community.

It's not likely to get much more edifying as we approach next May's general election.

Run out of ideas and running into the shit? Crack down on health tourism!
Health tourism crackdowns are the patriotism of health policy - the last refuge of the scoundrel.

There is a problem with health tourism at the very margins in the NHS, but it's not a big one, according to research for DH - worth maybe £60-80 million on the NHS's £115 billion budget.

Moreover, the NHS already works to recover costs from non-eligible patients,  as this House Of Commons Library briefing observes.

The DH press release has some hog-whimperingly funny lines about their plans:"Financial sanctions will also be put in place for trusts who fail to identify and bill chargeable patients". (How to identify providers who fail to identify such patients? Is there a national target, of the kind we no longer do?)

"Steps are being taken to help the NHS charge more effectively and consistently. A clear timetable has been issued and a new National Intensive Support Team will be on hand to assist." (Now I'm relieved. Steps, timetables and a national support team: what could go wrong?)

"A clearer registration process and IT system will help lessen the burden on busy staff. In summer, trials will start in some A&E departments to explore how details can be taken from patients with an EHIC when they register for care." (This keeps on getting even better: IT will make it all easy.)

"Options for recovering the costs of primary care services are also being explored. Eligibility to free NHS prescriptions, optical vouchers and subsidised NHS dental treatment will also be tightened." (What. The. Fuck?)

Oops. Sorry. I got slightly disrespectful there. Because this is a great idea, which will clearly raise enough money to save the NHS.

Taking a good idea to its logical conclusion
But it's such a good idea that I think it should go much, much further. The NHS could save the entire public sector. We could raise all the money required for a fervent social democrat's wet dream levels of public provision, and probably cut taxes to pretty much nothing.

We just need to extend the scope of NHS cost recovery more innovatively and imaginatively. This calls for thinking that is simultaneously bold and lateral. Blatteral thinking.

Why, for example, are we doing nothing about extra-terrestrial NHS users? I for one don't want those UFO-riding Men In Black (or Women In Black) taking a free ride on our luxurious public services every time one of their three heads gets a little headache.

You've seen those people in the suits walking around hospitals: they can't all be from McKinseys or Monitor (much the same thing, I agree).

There is clear scope for a National Programme For ET: it sounds like just the sort of thing that is bound to succeed brilliantly.

And we should be neither overly constrictive not traditional in our views on whom we should charge for their NHS care.

We don't want to miss out on an important, ever-growing demographic who could make a key contribution to protecting our public services.

I am referring, of course, to the dead.

The dead are significant, if hard-to-quantify, users of NHS services: a person down the pub told me so. This may not be true, but it's a fact.

Appropriate, proportional and of course means-tested charges on extra-terrestrials and the dead, backed by an IT infrastructure and a national support team, can safeguard our public services for decades to come, and help us cut taxes.

OK, that's that fixed. Any other problems anyone needs solving?