{"id":224,"date":"2009-12-23T15:47:45","date_gmt":"2009-12-23T14:47:45","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=224"},"modified":"2009-12-23T18:36:49","modified_gmt":"2009-12-23T17:36:49","slug":"public-spending-and-the-nhs-in-perspective","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/12\/23\/public-spending-and-the-nhs-in-perspective\/","title":{"rendered":"Public Spending – and the NHS in Perspective."},"content":{"rendered":"

I have a vague memory of John Lydon telling the crowd at the first Sex Pistols reunion gig in 1996 (Woo-hoo!\u00a0 I was there!) that he’d had a message of support from the owner of Creation records.\u00a0 “Don’t trust Alan McGee,” he snarled.\u00a0 “He’s a very clever man.”<\/p>\n

I’m beginning to think the same of Peter Mandelson, who is reported today to have announced plans to cut university funding by \u00a3533m<\/a> – or almost 7%.\u00a0 This is because it’s apparently enormously important that the government be seen to be doing something to suck up to the Daily Fail<\/em><\/span> cut spending in the run-up to an election.\u00a0 Naturally, there are all kinds of reasons why I think that a funding cut to higher education is bad, and my own job security isn’t actually first on the list.\u00a0 Nor is the worry about how the hell we’re supposed to cram all that teaching and marking into two years (let alone doing any research, given all the extra teaching weeks), or even a slide in standards, my biggest worry.\u00a0 No\u00a0– my main objection is to the gradgrindianism of a worldview that thinks that education is less important than training, and to the failure to see the value and – dammit – joy in spontaneous scholarship.<\/p>\n

But I thought it’d be interesting to compare university funding with NHS funding.\u00a0 The comparison is a bit rough-and-ready, but enlightening and a bit annoying nonetheless.<\/p>\n

The 2009-2010 settlement for the NHS<\/a> gives it a total resource of \u00a3102,897m, based on a revenue of \u00a398,499m.\u00a0 Yep: that’s just shy of a hundred and three billion<\/em> pounds.\u00a0 For 2010-11, that’s set to rise to \u00a3109,806m, based on a revenue of \u00a3104,833m.\u00a0 That’s quite a lot compared to the BBC’s quoted universities budget of less than \u00a38 billion, which is set to fall to a little over \u00a37 billion.\u00a0 This means that the rise in NHS spending is not much short of the whole of HE spending.\u00a0 Moreover, when we’re dealing with figures this large, it’s hard to see quite what difference is supposed to be made to the overall public spending figure by the proposed HE budget cut – though it’s all-too-easy to see what difference it’d make to the HE sector.\u00a0 (Imagine telling the NHS that it was going to lose 7% of its real-terms income…)<\/p>\n

So I’m already a touch worried about the justice question; granted that there’s a policy of reducing public spending, there’s grounds to worry that different areas of the public sector will get hit in inverse proportion to their electoral popularity.\u00a0 That’s bad news for universities (especially in the non-vocational disciplines), bad news for the arts, bad news for museums and so on.\u00a0 And it does seem to be unfair; if there’s a need or policy to reduce spending, then so be it.\u00a0 But it’s hard to square cuts in some sectors with planned spending rises in the NHS<\/a> – or at least protection from inflation (see p 103)<\/a> – \u00a0except that the NHS is politically VERY sensitive in a way that departments of Classics aren’t.<\/p>\n

But I suppose that the response to this would be that it’s important that cash continues to be channelled to the NHS.\u00a0 And, of course, it is.\u00a0 But the question that this prompts is one of whether, if we just transplanted\u00a0half a billion from HE into the NHS, it’d make any real difference.\u00a0 And it wouldn’t.\u00a0 It’s just not enough.<\/p>\n

What about the idea that the NHS is crucial to the economy?\u00a0 Again, of course it is.\u00a0 But the same seems to be true of the university sector.\u00a0 Sally Hunt of the UCU claimed on Today<\/em><\/a> that the university sector generates \u00a360 billion a year; that’s a pretty good return, and represents a lot of economic activity.\u00a0 So the idea that, in straighted times, we can do without luxuries such as high HE spending looks to be a crock – the HE sector makes us wealthier.<\/p>\n

But let’s pretend that it doesn’t; and this is where the comparison with the NHS comes into its own.\u00a0 Pretend that all the universities produce is idle scholarship, and all the NHS produces is healthy people.\u00a0 We could still ask this question: what would be the point of either output?\u00a0 What, that is, is the point of health, and the point of education?\u00a0 And it seems to me that both are vindicated as ingredients of some kind of eudaimonia<\/em>.\u00a0 We could build a plausible political theory on the premise that the point of a government is to guarantee flourishing.\u00a0 Welfare, in the sense of somatic health, might be a part of this; but the same could be said, I suspect, for what used to be called the “life of the mind”.\u00a0 That is, both health and education would count as components of the good life.\u00a0 Of course, different people might value either component differently; and it’s possible that health is more tangible as a component of the good life.\u00a0 But, all the same, education would be there.\u00a0 And it’s possible – probable, perhaps – that there are aspects of even non-vocational education that contribute more to aggregate flourishing than some aspects of health spending.\u00a0 I certainly see no a priori<\/em> reason to deny this.<\/p>\n

Now, if we can get that kind of argument firmed up, it’d be interesting to throw it at government spending decisions.\u00a0 We’re used to thinking that health spending is not only near-sacred – even right-leaning organisations are reluctant to announce restrictions on it – but uniquely so.\u00a0 But it’s not clear why this\u00a0should be.\u00a0 If the point of public spending is in the service of some kind of standard of flourishing, then other dimensions of the budget presumably have a correspondingly elevated status.\u00a0 And that means that a policy of cutting spending on some aspects of spending while making a point of not cutting it for others seems, at first glance, to be inconsistent.<\/p>\n

Don’t get me wrong.\u00a0 I’m all for high spending\u00a0on the health service.\u00a0 But I’m also for high spending on other things such\u00a0as the arts,\u00a0science, transport\u00a0and\u00a0education.\u00a0 If that means a little more tax, then so be it\u00a0– Sweden isn’t exactly a hell-hole.\u00a0 On the other hand, if you want less public spending, then while I disagree, I can see where you’re coming from.\u00a0 What worries me about this announcement, though, is that it’s ill-thought-through, potentially unjust, and painfully transparent politicking.<\/p>\n

Don’t trust Peter Mandelson.\u00a0 He’s a very clever man.<\/p>\n","protected":false},"excerpt":{"rendered":"

I have a vague memory of John Lydon telling the crowd at the first Sex Pistols reunion gig in 1996 (Woo-hoo!\u00a0 I was there!) that he’d had a message of support from the owner of Creation records.\u00a0 “Don’t trust Alan McGee,” he snarled.\u00a0 “He’s a very clever man.” […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[475,403,1543,1544,472],"tags":[],"class_list":["post-224","post","type-post","status-publish","format-standard","hentry","category-politics","category-rant","category-the-academy","category-the-nhs","category-thinking-aloud"],"yoast_head":"\nPublic Spending - and the NHS in Perspective. - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/12\/23\/public-spending-and-the-nhs-in-perspective\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Public Spending - and the NHS in Perspective. - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"I have a vague memory of John Lydon telling the crowd at the first Sex Pistols reunion gig in 1996 (Woo-hoo!\u00a0 I was there!) that he’d had a message of support from the owner of Creation records.\u00a0 “Don’t trust Alan McGee,” he snarled.\u00a0 “He’s a very clever man.” [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/12\/23\/public-spending-and-the-nhs-in-perspective\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2009-12-23T14:47:45+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2009-12-23T17:36:49+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/12\\\/23\\\/public-spending-and-the-nhs-in-perspective\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/12\\\/23\\\/public-spending-and-the-nhs-in-perspective\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Public Spending – and the NHS in Perspective.\",\"datePublished\":\"2009-12-23T14:47:45+00:00\",\"dateModified\":\"2009-12-23T17:36:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/12\\\/23\\\/public-spending-and-the-nhs-in-perspective\\\/\"},\"wordCount\":1128,\"commentCount\":2,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Politics\",\"Rant\",\"The Academy\",\"The NHS\",\"Thinking Aloud\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/12\\\/23\\\/public-spending-and-the-nhs-in-perspective\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/12\\\/23\\\/public-spending-and-the-nhs-in-perspective\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/12\\\/23\\\/public-spending-and-the-nhs-in-perspective\\\/\",\"name\":\"Public Spending - 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