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.


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

I agree with the comment above in that we should chase multi nationals and other tax avoiders.We should also greatly increase fuel duty as many health problems exist or are exasperated by pollution expecially pollution from diesel vehicles. Of course people do not help themselves in this respect as they can often be seen driving round and round in circles in Kingsbridge because they are too tight to pay for parking.They would also improve their health if they were to walk more often. The point being that people often do not take responsibility for their own health and therefore I do not think they should be entitled to free health care and should pay for use which would encourage many to take better care of themselves and avoid drinking like fish and smoking like chimneys. There are also many procedures available on the NHS which should not be as this was not the intentions when this institute was first founded. Finally just to calm the doomsayers, Brexit will not make any difference to the NHS or any other aspects of living in UK and will only improve matters. Oh also Sarah Wollaston's comment suggesting that living longer is something positive is subject to one's perspective and not something I would agree with.
- Derek

I believe the NHS is struggling because it undertakes procedures that should not be freely available and the sooner everybody and the government accepts this the better. There could then be more money available for procedures and treatments that truly related to one's immediate health. I do however believe the time has come to consider charging patients for their treatment. This would enthuse people to take better care of themselves as we are all aware of the need for improvement in our diets and the need to abstain from intoxicating liquor. It has recently been reported that the British eat the most processed foods and salty snacks of anywhere in Europe. Terrible diets. Cutting back on pollution from too many vehicles would also help by improving health and therefore reducing the burden upon the NHS. I do also have difficulties in regard to people suing the NHS. This gives me many sleepless nights as I cannot feel comfortable with someone suing a service that is essentially free and by suing only creates a greater burden upon the NHS. I myself have had a couple of procedures done under the NHS which have not been altogether successful, far from it,but to sue the NHS for this poor treatment I received, well I couldn't.
- Derek

With you on this one Sarah. Keep up the good work. This issue is of much greater importance to we Baby Boomers than Brexit, so please remind Mrs May of this fact. Do you have Jeremy Corbyn's phone number by any chance..?
- Roger Westlake

Surely it is time we change our political rivalries to one about our collective community in the same way of Denmark and the Scandinavian countries. That means us accepting higher taxes in return for guaranteed access to free healthcare, welfare, social services and education for all.
- John Lloyd

Mr Gunn’s comment is interesting I was about to add having just read CityAm that you sound like a socialist not a conservative. Frankly if you don’t support lower taxes, free markets and less government intervention you really are not a Tory. The NHS and social care need reform and desperately so but all you politicians think of is taxing us more! The wealthy already pay a disproportionate amount of tax as you surely know. It’s a blunt and retrograde instrument that has never worked and never will this has been proved so many times. You talk in your brexit blog about reading facts but conveniently ignore them in this issue. Free at the point of use for all is exactly part of the problem. Rich people and even middle class with insurance simply do not need free healthcare. This is a fundamental issue with the system in the same way they don’t need free bus passes etc and winter fuel allowances. I’m sure as a doctor you mean well being concerned with wellbeing but you’re applying the wrong logic and thus wrong solution. You must also be able to see the waste and inefficiency in the nhs? Come on Sarah time to be a real conservative! Real care for those in need is not throwing money at it!
- jeremy williams

The only 'customs arrangement' Brussels would accept involves accepting ECJ law, which isn't what we voted for.
- EP

THe NHS needed £4 extra a year to stand still, It did not get it 2025/27. Brexit with no customs deal will cost NHS ENgland alone £124 million a day in tariffs on drugs alone, 7 days a week, 365 days a year. Sarah knows this, it was told to her Health Committee on TV by the head of NHS ENgland. Theresa May has promised less than what they are owed for just one year BY 2022. Hilarious. Customs and Borders will cost £32billion a year after Brexit on top of what we pay now - for nothing. Brexit is costing one billion pounds a week and it is going on YOUR bill. The referendum cost half a trilllion pounds to stop the Tory financial market and companies going bust. You have to repay teh Bank of England. These will be accumulating every day after Brexit. If my vacuum cleaner was rubbish I would take it back, take back Brexit, we have been sold a pup.
- sivw

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