11 JAN 2018

Political courage is required and determination to properly fund the NHS and Social Care

Below is an article I wrote for the Financial Times

There is nothing new about winter pressures in the NHS. What has changed is that those pressures have become relentless, extending year round into traditionally quieter months but deepening in intensity over the winter. The current crisis is not simply caused by the number of people turning up to A&E but because those who do are far more unwell and many more need admission. With hospital bed occupancy already running at unsustainably high levels and a growing shortfall in community beds and workforce, the health and care system can rapidly become overwhelmed. An upswing in norovirus and flu over the past fortnight seems to have been the final straw. NHS England had little choice but to implement its emergency plan to ease the acute pressure by cancelling routine surgery until the end of January. Unless we address the underlying issues across both health and social care this will however become the norm for every winter. Beyond that the unsustainable pressures will result in a collapse in routine waiting time standards.

Increasing life expectancy is one of the greatest successes of our age, but as we live longer and with more complex conditions, health funding has lagged behind. There has been an abject failure on the part of successive governments to plan for the sheer scale of the long term demand and costs associated with demographic change and for the change required to integrate of health and social care,

The House of Lords Select Committee set up to examine the long term sustainability of the NHS rapidly concluded that it could not do so without including social care. The government needs to take note before repeating the mistakes of the past. A green paper that looks solely at long term funding for social care will miss the point that these two systems cannot be considered in isolation from each other. Neither should anyone underestimate the challenge of delivering policy change in a hung Parliament or under a government whose energy is so consumed by Brexit.

There is a way forward but it will take political courage from both front benches and genuine willingness to put the public interest first. Before Christmas, 90 backbenchers from across both sides of the House of Commons, wrote to the Prime Minister urging a cross Party whole-system approach to the challenges and funding of the NHS, social care and public health. Select Committees could also play a role to help to build on existing work and set out the options for the public. Theresa May's former Chief of Staff has advocated a Royal Commission but we do not have the luxury of time to kick this important issue into such long grass.

Many of the options have already been described, for example by the Barker Commission and recent House of Lords inquiry. The reality is that we will all need to be prepared to contribute more if we want the NHS to remain a universal service, free at the point of delivery and meeting our needs both now as well as in the future. This cannot in my view fall entirely on working age employed adults but also needs to consider inter-generational fairness, wealth and contributions from those who are self employed. As graduates struggle with student loans it would be unfair to expect them also to shoulder the increasing costs of health and care for those in retirement irrespective of their wealth. We could look at ideas for a hypothecated health and care tax for example paid by those over forty and with income from any source above a set threshold. Some advocate introducing charging and top ups but these bring higher transaction costs and widen health inequality. The point is that all these options should be clearly set out alongside the consequences of a failure to invest more in the NHS, care, public health and prevention.

Since 2010, total health spending has risen by an average of just over 1% per year. This is far lower than the long term average increase of around 4% and comes at a time of extraordinary rise in demand and the costs of drugs and technologies. Real terms cuts to social care have added to the strains.

It is time to stop viewing health as a bottomless pit but rather as one of our greatest successes and make increasing investment a source of national pride. I cannot think of a better way for Theresa May to celebrate the 70th anniversary of the NHS than by helping to make sure that it has a sustainable long term future.

2 comments

Not being a supporter of your government and a reader of many of your posts I have come to the conclusion you are in the wrong political party. Why, you yourself must realise the Tory party will never promote a system which benefits the many and not the few. Perhaps if your government went after the multi nationals that avoid paying tax in the U.K. We would have a fully funded NHS. Cheers.
- Peter Gunn

You're an excellent advocate for health and social care, and have long recognised that matters cannot remain as they are. I wish you were Secretary of State for Health, even though I wish the Conservatives were not in government. Political parties have studiously avoided the discussion and debate which is now so pressing and necessary. Surely, the UK should benchmark its standards and funding against the best providers in Europe and elsewhere, determine the standards that it should deliver, and develop the best funding model. You are so right about another Commission - that simply kicks the can down the road. As the Barker Commission commented, hard choices need to be made about tax and public funding. A political agenda to shrink the state to unsustainable levels runs contrary to the vital needs of health and social care, and the viability of public services. As a fortunate pensioner, I recognise that my generation should be contributing more, not least because we can afford it, so I support the idea of a health and social tax on the over 40s. More generally, regardless of the arguments against hypothecation, the concept will have public support because people are prepared to pay more if they believe the funds will be ring-fenced to support health and social care. I worry that Brexit can only make matters worse, in all the obvious ways, but also in the emerging decline of tolerance and compassion. You can make a real difference, and you are doing so. We need long term sustainable funding supporting a long term plan, and to the maximum extent practicable, a de-politicisation of these vital services. History is littered with the errors of successive governments in this arena, not least with constant restrucuring and the disastrous PFI initiative. There are many tough questions around funding, taxation, what should be free at the point of deilvery, and all kinds of bioethical dilemmas. But the nation cannot sit on its hands for any longer. The threat to your party is that the NHS/social care may bring down the government while it obsesses about fantastical solutions for Brexit, when it could have elected to remain in single market within the EEA. You're doing a great job, Sarah: please stay on the case, and let the public know what we can do to support you.
- Adrian Baskerville

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