Spending cuts must take the long view

The days of “growing our way out of recession” are over. It’s austerity measures from now on. We know the UK government’s budget plans (doi:10.1136/bmj.c3390), but what should governments around the world be doing to improve health? Should they prioritise health care or social welfare spending? And how can doctors help those affected by the fallout?

Two articles (one in this week’s print journal, the other just published on bmj.com) tell us that governments that want to improve health should adopt policies that reduce health inequalities and protect social welfare. Joan Benach and colleagues (doi:10.1136/bmj.c2154) say that fair employment practices—freedom from coercion, job security, a fair income, job protection, respect, and dignity—are not “nice to haves” in hard economic times. They have been shown to narrow the gap in health inequalities and to improve a nation’s overall health.

David Stuckler and colleagues develop the theme (doi:10.1136/bmj.c3311). Radical cuts in social welfare spending to reduce budget deficits could cost lives as well as causing economic pain, they say. Based on their analysis of data on social welfare spending in 20 European countries from 1980 to 2005, they argue that rather than protecting healthcare spending from budget cuts, governments should protect social welfare spending because it has a bigger effect on population health. When social spending was high mortality fell, but when it was low, mortality rose substantially.

GPs are at the front line dealing with the consequences, and things are going to get tougher still. Ingrid Torjesen looks at what many GPs are doing to add employment and education advice to their repertoire (doi:10.1136/bmj.c3114). Sam Everington’s Bromley by Bow Healthy Living Centre is one model. “The key five things that we are about”, he says, “are traditional biomedical health, employment, education, creativity, and the environment that people live in. All five are equally important in terms of the impact they have on people’s health.”

Times of financial constraint are when we most need healthcare managers and doctors to work together. The BMJ Group hopes to help with its new clinical leadership programme, run by BMJ Learning in collaboration with the Open University (http://bit.ly/cFPX6Z). Meanwhile, it’s a sad irony that one of the first casualties of the new austerity is the British Association of Medical Managers (BAMM); its activities have been suspended because of a hole in its finances. Founded in 1990, when medical managers in the NHS were a brave few, it has educated the two tribes—medics and managers—to begin to speak each other’s language. It has helped to shape the current view that we need more medical managers in the NHS, David Nicholson, NHS chief executive officer, is on record as saying that one in three NHS managers should be doctors. And through its juniors arm BAMMbino it has helped to inspire a growing body of young doctors interested in combining clinical and management training.

Now more than ever the NHS needs to find ways to bring doctors and managers together rather than letting them retreat back into their bunkers. Allowing BAMM to fail seems short sighted.