07 JAN 2018

NHS Funding

Below is an article that I wrote for the Sunday Express

There is nothing new about winter pressures in the NHS. What has changed is that those pressures are now year round but in winter the crisis is far deeper.

NHS England has put in place a plan to deal with this by cancelling routine surgery, but this will not feel 'routine' for those in pain awaiting a hip replacement for example. I understand the need to focus here and now on emergencies but we should not have to accept that cancelling this kind of life-changing surgery becomes the accepted annual response to winter.

The causes of these pressures are well known. It is of course great news we are living longer but as we do so we are living with far more complex long term conditions and the cost of treatment and technologies continues to rise faster than increases to the NHS budget. NHS staff have done an heroic job but they and the whole health and care system are stretched to the limit as they cope with far more people who are seriously unwell.

We cannot continue to provide the service we all expect on current finances, staffing and infrastructure. It is time for an urgent review to find the funding that both the NHS and social care need in order to make it happen.

We also need to end the culture of short termism and look not just at the here and now, but plan properly for the future and look at health, social care and public health together.

The public are being let down by a political failure over past decades to plan ahead, to be honest about the scale of the challenge and to work across Party lines to find a fair solution.

Before Christmas 90 back bench MPs from across political parties tried to change this, we wrote to the Prime Minister calling for this approach. Likewise in my role chairing the committee that calls the PM to give evidence, I told Theresa May that Select Committees (which work across Party political lines), stood ready to help. The fact is that no Party has a monopoly on good ideas on how this funding could be achieved and in a hung Parliament it needs cross Party working to get change such as this across the line.

No one wants to have to fork out but the truth is that we need to be prepared to pay more to support health and care services or services will decline. There are serious questions about whether it is fair for this to fall entirely on those of working age through taxes. My personal view is that it is not and that we should look at how it could be shared fairly across generations.

I know many people argue it is time to introduce charges to the NHS but this risks widening inequalities and also introduces costs and bureaucracy associated with collecting these relatively small payments. I know, as a former GP, that many of my sickest patients struggling on low incomes would have delayed coming to see me had there been a charge. This can end up not only with worse consequences for health but costing the NHS more in the long run. I also feel strongly that charging for appointments would go against one of the great founding principles of our NHS, that it is free at the point of need. It's what makes our system the fairest in the world and we should beware undermining that.

I believe the best way forward is stick with our tax and National Insurance based system as the core funding but look again at how National Insurance is collected and from whom so it can became dedicated to funding the NHS and social care.

It is time for an NHS and care convention to explore all the funding options and explain these clearly to the public and to look again at the options for sharing the costs of social care so that we no longer have the awful care costs lottery of one in ten people over 65 facing catastrophic costs.

A convention should not ignore the ongoing need to reduce waste in our NHS and I hear many examples of this in my work as chair of the Health Select Committee. Making sure that all areas learn from the best performing Trusts for example. Progress is being made in many areas already, for example driving down the huge variation in the amount the NHS pays for identical products. We also have to go further on prevention. Anyone who has spent time in an emergency department on a Friday or Saturday night will know how much drunkenness adds to the workload and avoidably ramps up waiting times.

It's easy to focus on the negative stories but the fact remains that our NHS and is doing a remarkable job and in its 70th year we should should celebrate it's successes and grasp the opportunity to make sure that it can not just survive but thrive. Rather than seeing health and care spending as a 'bottomless pit' we should view funding these properly as a source of national pride. These discussions have now become a national emergency and its time to ditch the Party politicical bickering and make it happen for the whole system our NHS, social care and public health.

4 comments

We need to end internal markets between primary & secondary health, between Community
- Debra Woodhall-James

You can have a good cheap job but it will be slow You can have a fast cheap job but it will be poor quality You can have a good fast job but it will be expensive Whichever way you slice it, this is the reality of life. If we want a good NHS which delivers promptly we will need to pay for it.
- Bob Bowling

It's time to charge for the use of NHS to encourage people to improve their health themselves where they are able to. Increased costs are generally attributable to a decline in personal care and the consumption of huge quantities of fatty foods and sugary drinks. Say it as it is. If someone choses to continue to eat junk which is detrimental to their health I see no reason why I nor any other person should then contribute towards the cost of their medical needs. The main area where the government can raise further funds via national insurance,if this is the route upon which they wish to continue,would be to collect national insurance on one's entire earnings instead of having a cut off point as at present.
- Derek

I generally agree with your points, but you repeat a common statement that "extra costs will fall on people of working age through taxes". I am retired but I still pay tax. Many people on low wages and benefits do not pay tax, so "working age" is very misleading. I agree that extra money could be raised through the NI, which is now just another general tax, but this would be an extra burden on employers, many of whom struggle with such overheads. Maybe the better way is to merge NI into income tax and then fund NHS from the pool, then anyone who earns enough to pay tax will contribute. As for change, what other organisation is based on a business model created 70 years go and never changed?
- S Morrissey

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