A new funding deal for the NHS: are we (and the NHS) ready to grasp the nettle?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham

“The NHS is being challenged to come up with a ten-year plan, setting out what we can all expect in return for the investment being made. Assuming that taxes rise to fund this new NHS settlement, there will be strings attached, ones that will likely mean a shake-up of the NHS. My fervent hope is that this will not be (yet another) organisational restructuring, but rather some serious modernisation of the way in which care is delivered, designed with close involvement of staff and patients, so that the NHS can truly be fit for a long and healthy future.”  

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So we now know that NHS England is going to get a new long-term funding settlement and that it is likely to amount to 3.4% p.a.  Announcements are still awaited as to how other elements of funding might be addressed, such as capital and equipment, public health and prevention, staff training and - most significantly - social care.

On the face of it, this new announcement by the Prime Minister responds directly to the stark warning from the BBC in May of ‘tax rises needed to prevent NHS misery’, which was issued following analysis by the Health Foundation and Institute for Fiscal Studies that suggested that just to keep providing the level of service it does today, the NHS needs an extra 3.3% of funding for each of the next 15 years.  Indeed, for the NHS to bring about modest improvements in its services, the Health Foundation and IFS argued last month that 4% annual rises in funding were needed, with 5% increases for a few years to kick-start the process of change.

We can see that the new announcement from the Prime Minister is a very welcome boost for the cash-strapped NHS and will certainly go a long way to address current pressures. It is however unlikely to be enough to bring about the wider change needed to modernise and improve care for the longer term.  Indeed, without any certainty about new funding for social care, it is hard to see how the NHS will be able to adequately meet the needs of an ageing population whilst also trying to ensure that new health technology, drugs and other innovations in care can be put in place.

If much-needed increases are also given to social care funding, the IFS and Health Foundation conclude that together with required additional funding for the NHS, the country will find itself spending 11.4% of national income on health and social care, compared with 8.4% now.  The authors of this analysis conclude that taxes will have to rise to fund this, given the general consensus that the British public will never tolerate having to pay more money directly for some health services in the way that people do in many countries, and much of the media debate in the past 24 hours has understandably turned to ‘how will we pay for this?’.

How will we pay for the new NHS deal?

As a nation we display rather contradictory behaviour towards the NHS, and I am no exception to this.  Watching the NHS Heroes programme recently, I lurched from feeling proud and emotional at the stories of exceptional care and service, to being somewhat unsettled by the constant applause at the mention by host Paul O’Grady of the word ‘NHS’, which jarred with what I know of the sometimes mixed experience people have of NHS and social care. I concluded that when being offered significant amounts of extra funding, we have to confront honestly the need for the NHS to change and improve, as well as cleaving to what is good and valuable about it as a universally provided and tax-funded service.

It is here that we face the crunch, for there are critical political questions to be answered about how much extra we are all prepared to pay for decent, modern and well integrated health and social care.  When the TV applause fades, and we await our pay packet at the end of the month, what will we expect in return for a larger tax or national insurance deduction?

I think the answer here is that we will now be much less tolerant of the old-fashioned delivery of some services such as not always being able to consult our GP on-line or by phone, receiving hospital appointments via paper letters, sometimes phoning multiple times to receive test results, and struggling to coordinate care for our frail elderly relatives in what is a fiendishly complicated and often fragmented care system.

As the old saying goes, to those to whom much is given, of them much will be expected.  I think this is now the case with the NHS as it works out how to accept and plan to spend its rather special birthday gift.  Indeed, the NHS is being challenged to come up with a ten-year plan, setting out what we can all expect in return for the investment being made.  Assuming that taxes rise to fund this new NHS settlement, there will be strings attached, ones that will likely mean a shake-up of the NHS.  My fervent hope is that this will not be (yet another) organisational restructuring, but rather some serious modernisation of the way in which care is delivered, designed with close involvement of staff and patients, so that the NHS can truly be fit for a long and healthy future.

Updated version of a previous post published 31st May 2018.

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