In July, it’s 70 years since the NHS was founded, providing cradle to grave health care tax-funded, free at the point of use, based on need not ability to pay.
The NHS has proved remarkably resilient over those 70 years but there have been bumps along the way. Thirty years ago Margaret Thatcher was in the midst of one of those bumps, with growing public discontent with rising waiting lists and nursing shortages contributing to increased pressure for more funding. Some extra investment was duly committed to the health service. Thatcher’s review of the service led to the introduction of market-based reforms, with the last concluding blast being the Health and Social Care Act of 2012. Similarly, in the midst of a spending squeeze in the late 90s, public satisfaction with the NHS was at an all-time low. After sustained funding increases through the 2000s, levels of satisfaction doubled to a record 70 per cent in 2010.
The critic’s charge sheet for the current NHS has great similarities to those times. Waiting lists were at the historic high of four million in March 2018. One in 10 nursing posts are vacant and GP numbers are falling. There is a widespread belief that once again funding, or lack of it, lies at the heart of these problems. NHS funding is planned to grow by 2.3 per cent a year under Theresa May’s government, compared to 3.3 per cent a year under Thatcher and John Major and almost 6 per cent under Tony Blair and Gordon Brown. We are in the midst of the most austere decade in NHS history.
In March, May committed to a long-term funding settlement for the NHS. There is a powerful political case for trying to get on the front foot here. Support for the institution is rock solid—77 per cent support the NHS in its current form, a figure that has rarely shifted in two decades, but public satisfaction with care is starting to fall and concerns about the NHS top the worry list for voters—above even Brexit.
Sorting out the NHS will not be easy. A study out this week by the Institute for Fiscal Studies and the Health Foundation has looked at NHS spending pressures over the next 15 years. A rapidly ageing population with more long-term health problems means rising demands on the system. Current spending plans fall well short of what is needed to hold the line on quality and access to care. UK spending on the NHS would need to go back to the growth rate of the Thatcher years to maintain services are current levels, increasing by an average of 3.3 per cent a year. With more chronic disease the NHS needs to run to stand still.
But looked at over the longer sweep of history, the NHS has never sought to stand still. The major strides in survival rates from cancer, stroke and heart disease are a tribute to the power of science and medical advance but also the importance of a well-funded NHS to ensure people can access these pioneering new treatments.
There are major challenges that need to be addressed—not least the gaping holes in access to mental health services which see only four in 10 people who need it getting treatment. To improve NHS services over the next 15 years would mean funding growing at more like 4 per cent a year above inflation. That is the sort of number that scares politicians but it exactly matches the rate of growth over the first 60 years of the NHS before the recent years of austerity. In 1948 if anyone had set out projections for spending on the health service of 4 per cent a year above inflation many people would have thought it unaffordable. Yet spending grew by that rate and the sky did not fall in. We may have a problem with our public finances post-2008 but the NHS is not the cause.
May faces a big decision; increasing spending at this rate almost certainly means tax increases at some point in the future. A higher deficit is possible in the short run, but not permanently; it is not clear that there are large areas of public spending that could be cut to pay for more health care; scope for significant additional NHS charging is limited.
So, there are two alternatives; take your chances with the NHS and allow managed decline or commit to extra funding, accepting that at some point in the medium term that will mean some increase in tax. Tax rises are rarely popular but recent King’s Fund polling suggests the public is prepared to put its hand in its pocket for the NHS.
The government’s nervousness is heightened by worries about whether extra money will deliver improvements in care that are big enough for the public to notice. If you are a politician it can often seem that putting money into the NHS is a bit like pouring water into sand. But over decades the extra funding for the NHS has not been wasted. For almost any major disease you could name, your chances of surviving today are higher than at any point in the last 70 years. Public support for the NHS is not sentimental, it reflects the vital impact that access to high quality care has on people’s lives.
Fund the NHS through tax rises—or accept that it's managed decline from here
A new study makes clear the amount of extra cash needed
May 24, 2018
Embargoed to 0001 Thursday April 26 File photo dated 15/08/14 of a hospital bed, as it has emerged that one hundred NHS hospital patients may have died last year after their deteriorating health was not spotted by medics.
