Amazingly erratic NHS financial management

Running the NHS is like steering a supertanker. It responds with majestic inertia to a whirl on the wheel, but before you know where you are, you are ten miles out to sea. Given a simple objective, the service seldom fails. But it can easily overcompensate. Two years ago the order went out to balance the books and save Patricia Hewitt’s job as Health Secretary. The books have been duly balanced, though Ms Hewitt was still cast to the sharks. But, having eliminated the deficits, the NHS is now heading for an embarrassingly large surplus of almost £1.8 billion this financial year.

Under Treasury rules all of this money stays with the NHS. But that is small compensation for the hundreds of patients denied access to modern drugs this year because the NHS said that it couldn’t afford them. It also makes the promise by Andrew Lansley, the Shadow Health Secretary, to spend still more on the NHS look even more ill-timed.

Where will the money be spent? The Department of Health would like us to believe that it will be invested in new and innovative services. (The art of making spending sound virtuous is to call it investment.) In practice, all that will happen is that the NHS will relax its controls. The cost savings were made in 2006-07 by squeezing emergency care, reducing the prices paid to hospitals for such care and cutting staff by 8,500 – the first fall in numbers for ten years. Staff numbers only have to begin creeping up again and the surplus will disappear. Cost-of-living salary increases have also been under tight control, which cannot last for ever.

And the whopping surpluses made by the strategic health authorities have come in part from raiding their training budgets. That is another short-term economy that cannot realistically be extended indefinitely.

So, the impression that the NHS has suddenly become much more efficient is, alas, an illusion. It has jammed on the brakes, squeezed its staff and denied some patients the care they would take for granted in other countries. As a result, it is in surplus. But it won’t last.

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Turn your nose up at eco-snobs

What was it, this frisson that passed between the young woman behind the counter at Pret A Manger and me? It wasn't flirtation, exactly. It was more conspiratorial than that. A knowing look. A social judgment shared. As she asked me if I wanted a plastic bag for my two items - a (wild) salmon sandwich and a banana - the man at the head of the queue next to mine was asked the same question by another assistant. He had a sandwich and an apple. The point is, I said no. He said yes. That was when the look was exchanged

That, I am ashamed to admit, was the moment I felt superior, if only by one degree, if only for a second. The man had committed a faux pas. He had transgressed an unwritten ethical code. He had fallen foul of the new morality, which actually, if you think about it, is also the new snobbery. It is apparent everywhere. In a restaurant the other night our companions asked us if we wanted sparkling water or whether we were happy with a jug of tap. The clue to the correct answer was in the word "happy". We went with the tap. It wasn't that we were being cheap - but we probably were being a little smug. My wife and I are paid-up members of the enlightened middle classes, you see. Our consciousnesses have been raised. We are E, the modern equivalent of U.

Just as Nancy Mitford divided society into the upper classes and the aspiring middle classes - that is, into U and Non-U - so society is being divided into the environmentally aware and environmentally unaware, or E and Non-E. It satisfies a need we seem to have to judge one another. The modern equivalent of saying "toilet", "serviette" or "pardon" is leaving your television on stand-by, driving a Chelsea tractor [SUV], arriving at Waitrose [a supermarket that believes in "Corporate Social Responsibility"] without your own heavy-duty carrier bags, popping into Starbucks without your own reusable mug, walking past the shelves selling organic, Fairtrade and free-range, or flying long-haul when you don't really need to (and without offsetting your carbon footprint). I tell you, it's a social minefield out there.

Even going to Glastonbury [A mostly hippy festival which is supposed to be "spiritual"] has become Non-E. I know - that surprises me, too. I thought Glastonbury was the ultimate in environmental chic, a demonstration that you suckle at the teat of Mother Earth, that you are in touch with your inner solstice. But no - for the bien pensants, Glastonbury is ruled out this year. And this comes straight from the top: Thom Yorke, the lead singer of Radiohead. Why? Because it doesn't have "an adequate public transport infrastructure in place". Radiohead, he added in an article in the Sun on Thursday, "are doing everything we can to minimise our impact on the environment".

Hmm. Could this be the moment when the backlash starts? It is, after all, a scientifically verifiable fact there is nothing in this world more annoying than being lectured by a pop star. According to this premise, the blame for the Iraq war rests squarely on the shoulders of Ms Dynamite. Had she not argued in March 2003 the invasion should not be allowed to happen, it wouldn't have happened. Her annoying intervention was, for George W Bush and Tony Blair, the tipping point.

Being harangued by a newspaper comes a close second. The Independent has been banging the environmental drum for a few years now - ever since its editor-in-chief, Simon Kelner, had lunch with Laurie David, Hollywood's richest and most glamorous eco-warrior, the woman who holds "eco-salons" for Leonardo Di Caprio, Cameron Diaz, Angelina Jolie et al. But at least the Independent?'s heart is in the right place.

More disturbing is the come-lately arrival on the eco-worthy scene of the Daily Mail. About five years ago that paper's standard response to an eco story was merciless ridicule. Last week it dedicated its front page to a campaign to stop us using plastic bags. Perhaps its canny editor had tested the air and knew that Sainsbury's and Tesco were about to announce plans to reduce plastic bags by a billion a year anyway. Hmm, again.

Being lectured by a posh person comes third. I wonder how much longer the green revolution took to filter into the mainstream because the Prince of Wales was leading it. Don't get me wrong, I think he is a visionary, a true philosopher prince. But given that the other two leading figures in the green movement, the Eton-educated Jonathon Porritt and the Stowe-educated George Monbiot, are also pretty posh, there may have been some inverted snobbery in the slowness of the eco uptake.

On the other hand, perhaps in some subliminal way this association of greenness with poshness explains the current vogue for going green among the aspiring middle classes. David Cameron (Eton-educated, of course, and for once this seems relevant to the discussion) has been canny in the way he has exploited this fashion.

I hope there isn't a backlash, by the way. I'm all for recycling, sustainability, diversity, lowering carbon emissions and everything. But I do think the eco-awareness game has to be played more subtly than it is being played at the moment. When the BSE scare was at its height, there were those contrarians among us who made a point of ordering rare beef as a gesture of defiance. Others deliberately wore fur when that became the cause celebre.

When councils start preaching at us, that really winds us up. If people were allowed to use recycling bins when they needed to, I reckon they would. But we resent being treated like children and told we can't have collections every week because we don't know what's best for us.

And how galling it must be for my parents' generation to be told not to waste things when they have lived through rationing and know all about the benefits of frugality. If there is one thing the British hate more than having their environment needlessly destroyed, overheated or squandered, it is being preached at by busybodies, puritans and snobs.

The eco-snobs are the worst. It is not enough they get to feel better about themselves for doing the right thing environmentally; they have to make someone else feel worse. Make them feel small, vulgar, immoral. I caught myself doing it in that queue the other day. And shame on me for that.

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There is a new lot of postings by Chris Brand just up -- on his usual vastly "incorrect" themes of race and IQ.