BMJ

EDITOR'S CHOICE: Spending cuts must take the long view

Author(s): Fiona Godlee
Source: BMJ: British Medical Journal, Vol. 340, No. 7761 (26 June 2010)
Published by: BMJ
Stable URL: http://www.jstor.org/stable/20734597
Accessed: 09-10-2015 17:33 UTC

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EDITOR'SCHOICE

Spending
Times of financial
constraintarewhen
we most need
healthcaremanagers
and doctors towork
together

cuts must

take the long view

The days of "growingourway out of recession"are over.

measures fromnowon.We knowtheUK
It'sausterity
government'sbudget plans (p 1378), butwhat should
governmentsaround theworld be doing to improve
health?Should theyprioritisehealth care or social

welfare spending?And how can doctorshelp those

affectedby the fallout?
Two articles (one inthisweek's printjournal,
theother justpublished on bmj.com) tellus that

governmentsthatwant to improvehealth should adopt

policies thatreducehealth inequalitiesand protect
socialwelfare. JoanBenach and colleagues (p 1392)
say thatfairemploymentpractices-freedom from
coercion, job security,a fairincome,job protection,

respect,and dignity-are not"nice to haves" inhard

economic times.Theyhave been shown to narrowthe
gap inhealth inequalitiesand to improvea nation's
overallhealth.
David Stucklerand colleagues develop the theme

(doi:10.1136/bmj.c3311). Radical cuts insocial

welfare spending to reducebudgetdeficitscould cost
livesas well as causing economic pain, theysay. Based
on theiranalysis ofdata on socialwelfare spending in
20 European countriesfrom1980 to 2005, theyargue
thatratherthanprotectinghealthcarespending from

budget cuts,governmentsshould protectsocialwelfare

spending because ithas a biggereffecton population
health.When social spendingwas highmortalityfell,
butwhen itwas lowmortalityrose substantially.

O Twitter Followtheeditor,
FionaGodlee, at twitter.com/
fgodleeand theBMfs latestat
twitter.com/bmj_latest

GPs are at the frontlinedealingwith the

consequences, and thingsare going toget tougherstill.
Ingrid
Torjesen looksatwhat many GPs are doing toadd
employmentand education advice to theirrepertoire
(p 1386). Sam Everington'sBromleybyBow Healthy

Articlesappearing inthisprintjournalhave already

been published on bmj.com,and theversion in
printmay have been shortened, bmj.comalso
containsmaterial that issupplementaryto articles:
thiswill be indicated inthe text(referencesare
given as wl, w2, etc) and be labelled as extraon
bmj.com.

Please cite all articles byyear,volume, and elocator

(ratherthanpage number),eg BM) 2009;338:bl45.
A note on how to cite each article appears at
the end of each article,and this is the formthe
will take inPubMed and other indexes.
reference
Career Focus, jobs, and courses

LivingCentre isone model. "The keyfivethingsthat

we are about," he says, "are traditionalbiomedicai
and the
health,employment,education, creativity,
environmentthatpeople live in.All fiveare equally

importantintermsof the impacttheyhave on people's

health."

Times of financialconstraintarewhen we most

need healthcaremanagers and doctors towork
together.The BMJGroup hopes to helpwith itsnew

clinical leadershipprogramme,runbyBMJLearning
incollaborationwith theOpen University(http://bit.
Meanwhile, it'sa sad ironythatone of
ly/cFPX6Z).

the firstcasualties of thenew austerityistheBritish

Association ofMedical Managers (BAMM); itsactivities
have been suspended because ofa hole in itsfinances
(see Careers). Founded in1990, when medical
managers intheNHSwere a brave few,ithas educated
the twotribes?medics and managers?to begin to
speak each other's language. Ithas helped to shape
view thatwe need moremedical managers
the current
intheNHS, David Nicholson,NHS chiefexecutive
officer,ison recordas sayingthatone inthreeNHS
managers should be doctors.And throughitsjuniors'
arm,BAMMbino, ithas helped to inspirea growing

body ofyoungdoctors interestedincombiningclinical

and management training.
Nowmore thanever theNHS needs to findways to
bringdoctors and managers togetherratherthan letting
them retreatback intotheirbunkers.AllowingBAMMto

failseems shortsighted.
Fiona Godlee, editor,fiMytgodlee@bmj.com
Citethisas: BMJ2010;340:c3387

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