The run up to the NHS’s 70th birthday has been dominated by speculation about the Prime Minister’s commitment to a new long-term funding plan for the NHS.
It is an open secret that the discussions within Whitehall have been fraught, with the Treasury resisting too great a raid on the public purse and the Department of Health arguing that any increases must be significant – a view, that the Health Secretary Jeremy Hunt insists, the Prime Minister shares.
But, away from Whitehall, there is remarkable consensus about how much the NHS needs. Countless organisations, including mine, have seized on the Prime Minister’s words to highlight what most recent independent analysis shows: spending increases of at least 4 per cent above inflation each year are needed to prevent a slow decline in patient care.
The rub is in the politics. The sums of money are large, and as the Institute for Fiscal Studies (IFS) have recently shown, all roads seem to point towards tax rises. But the thorny politics of how much shouldn’t detract from an equally important policy question: how to spend it.
Many will undoubtedly worry that, with about 100,000 vacancies, the health service simply doesn’t have the staff to spend the money effectively. Others will point to the yawning deficits affecting hospitals and say these will swallow any increases.
These are valid concerns, and the NHS will have to show that it is using the money wisely. That’s why a two-part relief and investment plan is needed.
Relief needs to deal with the effects of years of underfunding in the NHS. These include: tackling the £1 billion critical maintenance backlog facing NHS hospitals; helping find alternative care for the thousands of patients stuck in hospital; and reducing the growing numbers of patients on the waiting list for treatment, which stands at about one in 14 people in England.
To deal with the workforce crisis, the Government should: fill vacancies through ending the visa cap on doctors; reintroduce nursing bursaries for mature students wanting to work in the community; and develop strategies to bring experienced staff, who have left, back into the health service.
The investment part of the plan should prime the NHS to change from a service that treats illnesses to one that also helps people manage their long-term health needs.
This should accelerate existing work in reshaping the boundaries between hospitals, family doctors and community health services: making sure hospital specialists work regularly with GPs and their patients instead of relying on referrals; reinstating and expanding training for district nurses; and promoting greater use of video and app technologies.
This should be accompanied by investment in public health, such as boosting the numbers of health visitors and promoting healthier lifestyles.
Such a relief and investment plan will fall flat unless accompanied by equally bold plans on funding social care, also due to emerge this summer.
But the result should be a more joined-up health service, with doctors working closely with other professionals – dieticians, pharmacists, district nurses, health coaches, care navigators, health visitors and care workers – to provide better support for people living longer with multiple conditions.
This plan will not be cheap. The Government will have to deliver big enough increases to enable any change to be meaningful, otherwise we will be back at square one before we know it. But in return, politicians should expect to see early results in ample time for the next election, with shorter waiting lists and better access to GPs.
Can politicians grasp the nettle to find the money the NHS needs and ensure it is spent on the right things? We are about to find out.
Edwards N (2018) "How to spend it: what to do with new NHS money”, Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/how-to-spend-it-what-to-do-with-new-nhs-money