Prime Minister’s Theresa May’s speech on the NHS looked forward to the 100th birthday on the NHS in 2048, while Secretary of State for Health and Social Care, Jeremy Hunt looked forward even further to its next 70 years. However, will the birthday present of more funding allow it to survive even until its 80th birthday?
As with previous views on the NHS, there are glass half full and half empty versions. One obvious glass half full view is to raise a birthday toast to the NHS simply because it is still here. Over the years, but especially since the 1980s, many commentators have pronounced the end of the NHS. However, like Mark Twain, announcements on is death have been premature (Powell 2015).
Aneurin Bevan was confident that the NHS would survive (and it is obligatory to mention ‘Nye’ in every discussion on the NHS, as May did). Like Nye, I am confident that the NHS will survive, in some shape or form. However, I am equally sure that the birthday present of an additional £20.5 billion in real terms by 2023/24 (or an average growth rate of 3.4 per cent each year) will not, as claimed by May, lead to a ‘similarly profound transformation to the foundation of the NHS’. (Hunt mentioned the ‘t’ word 5 times in his speech, while May mentioned it 7 times).
First, the promised growth rate is less than the historical growth rate in funding since 1948. Second, this comparative feast follows the worst famine in the history of the NHS. Much of this funding will go to repairing the roof rather than to ambitious new building plans. Third, the money may be both too little and too much at the same time. A below historical average growth rate will hardly transform the NHS, especially at a time with a rapidly ageing population. However, in the short term, it is not fully clear how the NHS will use the money to best effect. We have fewer hospital beds, doctors and nurses compared with most other economically developed nations. It takes time to build new facilities and to train new staff. Fourth, similar promises have been made in the past… and have rarely been delivered in full. To some extent, this is copying the homework of the last Labour government. The current promised ten year plan that provides investment in return for reform sounds very similar to the ‘NHS Plan’ of 2000 from Tony Blair’s Secretary of State for Health, Alan Milburn. Fifth, at present (pending a Green Paper on Social Care due very soon; and a wider spending settlement), the grand vision does not include social care, which is like buying an expensive designer bucket to catch a leak without calling a plumber to fix it.
If the phoenix is to rise from the ashes, by its 75th or 80th birthday, the NHS will need – in addition to its 70th birthday cash present- an integrated National Health and Social Care Service (to match the name of the newly established ‘Department of Health and Social Care). If so, life may begin at 70 for the NHS, and it can look forward to a long and happy old age.