Just over two years ago, as the 2015 General Election loomed, the political parties entered a curious bidding war on NHS funding. The Conservative, Labour and Liberal Democrat manifestos contained specific detail on the future funding of the health service, with round numbers on NHS spending pledged by all three of the then largest Westminster parties.
A look back at the 2015 manifestos
At the time we pointed out that each pledge, despite the detail, left many questions unanswered – from only having a plan for the first two years after the election (Labour), to leaving the NHS short of funds at the start of parliament (Lib Dems), to not specifying when the money would come on-stream (Conservatives). In the event, the Conservatives won the election and pledged £8 billion (or was it £10 billion?) for the NHS up to 2020. It was hoped that this sum would help bridge the gap between funding and need, assuming the NHS was able to make huge and unprecedented (and some might say fairly unrealistic) efficiency savings.
At the same time, the Conservative party’s pledge provided the Government a shrewd response to the continuing financial woes of the health service by allowing politicians to claim they had given the NHS what it asked for. In reality, of course, the impact of continued growth in demand for health care and the financial squeeze on public health and social care have dwarfed the impact of the extra funds pledged. But election pledges and hindsight rarely mix.
Setting the scene
Fast forward two years, and we find ourselves facing a General Election under wholly different circumstances. The UK’s exit from the European Union looks set to become the defining feature of the next decade of public policy – squeezing out time, money and talent desperately needed for the development and implementation of domestic policy.
Meanwhile, the NHS could end up being pushed into a supporting role in the election campaign, despite growing public concern about the quality and availability of health care and the worsening financial picture. And while there is broad consensus that social care funding needs a fix, exactly how to achieve this with a slowing economy and a workforce heavily reliant on overseas workers is anyone’s guess.
Priorities for 2017
Yet it would be a tremendous lost opportunity if manifestos do not seek to put both health and social care funding on a more sustainable footing, outline a clear intention to address the looming workforce problems in both sectors, and give Government the space to provide the financial and legislative support the NHS needs to transform services.
There is genuine concern within the NHS that the next three years will be almost impossible to deliver on the current funding settlement without concerning implications for the quality and availability of care. In the medium term, while drives to integrate health and social care and transform health services are welcome, they will take time to deliver and will not generate savings on the scale politicians might wish for. And in the longer term, evidence suggests that while a centrally-funded, free-at-the-point-of-use health care system is sustainable, this will require increases in the NHS budget that are significantly higher than those it has had since 2010 – and that are, indeed, closer to the historical average of 4 per cent a year.
While specific sums of money may make good election slogans (not to mention referendum slogans), there is a real danger in making overly specific pledges on health and social care funding. In the current environment, any amount that is politically credible is unlikely to be fiscally credible unless services are to be reduced. Instead the manifestos should afford Government the flexibility to respond to the changing landscape and outline a commitment to a free-at-the-point-of-use, taxpayer-funded NHS, accompanied by a pledge to deliver a sustainable long-term settlement for both health and social care spending soon into the new parliament. Some clarity about how the next Government will find the money if services turn out to need even more funds than anticipated would provide credibility and certainty for the taxpayer. Any settlement must be accompanied by a continued focus on value for money and a long-term strategy for productivity improvement.
The funding problems facing health and social care have the potential to be swamped by an even bigger challenge that will present itself to any new Government soon into their period in office: the crunch facing the health and social care workforce. Staff shortages, dwindling morale and the looming impact of Brexit on a sector already dependent on overseas workers promise to make the next decade extremely challenging. The new Government will need to support initiatives to address the impact of these pressures. Accepting that nurses may need to stay listed as a shortage occupation, ensuring a joined-up approach across government departments to the recruitment of overseas workers, addressing staff shortages, and supporting workforce development would be a good start.
A changing landscape
As well as funding and workforce issues, a new Government will inherit an NHS in the midst of a major change programme. The Five Year Forward View offers the right vision for the health service by shifting care closer to people’s homes, but is unlikely to be realised without upfront investment in community services alongside hospital care and changes to the legal status of some NHS bodies.
The Sustainability and Transformation Plans (STP) process has undeniably had a rocky start. But it has helped local organisations forge new relationships and set in train plans for reforming care that are long overdue. Instead of risking a further distracting reorganisation of the NHS, any future Government should go with the grain of these reforms and support local areas in changing the way care is delivered. This will mean the new Government supporting bids for capital funding where required, leaving open the option for legislative changes to formalise STP structures and, in time, making changes to ensure that the 2012 Act does not stand in the way of collaboration.
In the clamour for headlines in the heat of an election campaign, there is a temptation to address policy issues with one-off pledges for sums of money or staffing numbers. But it is clear that both health and social care need a more thorough and long-term approach. Such an approach must provide a clear strategy for change while at the same time delivering the high-quality, publicly-funded health care and access to social care that the public expect. Not tackling this has the potential to cause serious problems over the course of the next parliament and beyond.
Edwards N (2017) 'Manifestly important: health, social care and the General Election'. Nuffield Trust comment, 3 May 2017. https://www.nuffieldtrust.org.uk/news-item/manifestly-important-health-social-care-and-the-general-election