Public expenditure rules and the NHS

Certain rules have been developed on the minimum increases in public spending needed to cover the costs of aging and the costs of new technology. In practice elderly people only use certain kinds of service and much of the increase has had to be used to finance changes in other services. From 1978 to 1982 the number of people in ENgland over 75 grew by 250,000, needing an extra £220 million at 1982/3 prices but spending on age sensitive services rose by £116 million. Such spending should be evaluated separately and allowance for the extra costs of aging should actually be spent on those services. The problems of 'technology' really involves a small number of treatments which have heavy demands on in-patient resources. Smaller changes in technology can be financed through normal capital and revenue budgets. There should be a special fund to cover the small group of innovations which make heavy demands on in-patient resources. There should be an evaluation and selection carried out by a panel with local as well as central representatives. The planned programme for introducing brain scanners could serve as a model.