When every year feels chillier than the last, what are the solutions?by Tom Clark / December 9, 2018 / Leave a comment
It’s easier being shadow health secretary than the real thing at the moment. The last couple of winters have been desperate in many hospitals, and Jonathan Ashworth (below) doesn’t miss a trick in drawing together the abundant evidence that this year’s could be worse.
But the NHS’s disease is easier to diagnose than cure. Does it, as Labour sometimes suggests, all boil down to money? In the first few years of austerity, there was room for argument—the squeeze that began around 2010 did not immediately translate into worse services for patients, perhaps because the service had some fat to live on then. But the effect of tight budgets is cumulative, and from 2014 the first warning lights began to flicker, and with every year that passes they are flashing brighter. Ashworth focuses on hospital corridors; overleaf former NHS chief executive, Nigel Crisp, talks about community services; and in last month’s Prospect, we wrote about a crisis in GPs’ surgeries. In every area, inadequate resources are indeed at the heart of the malaise.
So money is a huge part of the NHS problem, and yet money is unlikely to fix the whole thing. We now have a Conservative government that is openly prepared to countenance tax rises to fund the NHS, as well as council tax rises to bail out the stricken social care services that intensify the pressures. But neither it—nor Labour—are talking about ear-marked tax rises that are anything like enough to sustain the service as the ageing of our population picks up pace. Cash-strapped as it may be, the NHS has enjoyed more protection than other parts of the state—its share of the public service spending pie is up, the IFS reports, from 23 per cent in 2000 to 29 per cent in 2010 and a planned 38 per cent in 2023.
All this points, for me at least, to money remaining tight. Policy will need, as Crisp recommends, to empower professionals to work smarter. It must also face up to painful mergers, and crack down on the profiteers at the margins of the system. It won’t be easy. But the alternative is every winter being chillier than the last.
Jon Ashworth: Accidents and emergencies
Nigel Crisp: A community problem