How to design a sustainable post-pandemic settlement for the nation’s favourite institution?by Jennifer Dixon / July 3, 2020 / Leave a comment
Sunday 5th July, the 72nd anniversary of the creation of the NHS, will see the last planned clap for carers at 5pm. Like the rainbows in windows across the UK, the clap is a tangible sign of the almost religious sanctity of the NHS in the public psyche. When all else fails, the NHS represents unqualified and free social protection writ large, and it arguably has never mattered more than in the last three months. In a world full of services having small print exclusions, dodging obligations, offering qualified support or lapsing in quality, doing whatever it takes for those in need is the NHS’s enduring appeal.
“Whatever it takes” was also the message from the Chancellor Rishi Sunak in mid-March, referring to emergency government financial support for the economy and the NHS. The bill is forecast to be close to £300bn in 2020/21, according to the Office for Budget Responsibility. Despite assurances that there will be no return to austerity, cutting future public spending remains a possibility. Polling consistently shows the public wants more spent on the NHS over other areas. But with a tax-funded budget of £125bn and 1.4m staff, the NHS in England is the largest organisation in Europe.
Governments have a penchant for administration-defining reforms. Given Covid-19 and Brexit, you’d be forgiven for thinking the current crop’s agenda was already well defined. But think again. The whole civil service is due a downpour of “hard rain,” according to the PM’s chief adviser Dominic Cummings, with the aim of modernising “the blob.” With health steadily increasing as a share of total public spending (now standing at nearly 20 per cent), the NHS may soon be in the crosshairs for reform again too. We’ve collectively renewed our vows to the NHS, so what’s next?
First, anyone worried about future costs of health care must tackle the sheer burden of illness the NHS faces. Gains in life expectancy have stalled in England over the past decade, there is a growing gap between rich and poor, and in some groups (eg women living in deprived communities in the north of England) life expectancy has reversed. People living in the poorest areas start getting chronic diseases at 51—a full 19 years before those in the wealthiest. We…