THE GOVERNMENT'S reforms of the NHS five years ago may have brought improvements in terms of more patients being treated and waiting lists being cut - but has the price been worth it?

For today Labour claims the upshot has also been a hugely expensive red-tape bill spiralling out of control.

They claim that the salaries of NHS managers in England are now costing £1,100million more each year than they did before the reforms.

Spending on their pay, they say, plus that of administrative and clerical staff rose to £2.3billion.

And, measured in actual care terms, they say the boom in the bureaucracy bill costs the NHS the price of more than 100 hip-replacement operations every day.

It is, of course, shocking to see so much money being spent on administration instead of at the sharp end of the service.

And it is all the more disturbing when rationing and pressure on resources throws up tragic cases like that of Jaymee Bowen, the child cancer victim denied NHS treatment, and of desperately-ill children being ferried from hospital-to-hospital because of a shortage of special intensive care beds.

However, as well as attacking the red tape explosion created by government's reforms, Labour seems also to be playing the politics-of-envy over managers' pay - the bill for which is exaggerated since, in many instances, it includes the salaries of people providing daily hands-on patient care, but who happen to be in managerial pay grades. The senior managers whom they tar as fat cats represent only some two per cent of the workforce, and their pay accounts for three per cent of the NHS wages bill, compared with the 65 per cent of the wages bill that is taken up by staff directly caring for patients.

That said, there is no doubt that spending on administration has risen dramatically since the internal market in the NHS began in 1991.

But that was inevitable and predictable since the government was able to look at the administration costs of the commercialised care system in America consuming 20 per cent of its budget, as opposed to less than four per cent in our health service before the reforms.

The issue, then, is whether the improvements brought by the reforms are real enough and provide greater value for money than the booming bureaucracy bill that comes with them and which consumes large sums which might otherwise have been spent on patient care.

That question has not yet been satisfactorily answered.

But while the government is sufficiently embarrassed by the red tape bill to have ordered crackdowns and cuts in the administration payroll, even Labour, on the offensive today over the NHS reforms, has not yet pledged to scrap them wholesale - suggesting that they just might be working.

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