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May 5, 2015

Private Eye Issue 1340
Filed under: Private Eye — Dr. Phil @ 8:40 am

Funding the NHS fantasy promise auction – whose policies add up?

The pre-election NHS rhetoric has descended into a predictable fantasy promise auction. Politicians know they don’t have a hope in hell of providing a 7 day NHS (Tory), a same day GP appointment for anyone over 75 (Tory), or a midwife by your side every minute of labour (Labour). Even if the money was available, where would we suddenly grow 8,000 more GPs, 20,000 more nurses and 3,000 more midwives (Labour and UKIP)? And is being able to see a GP on a Sunday afternoon really the best use of the NHS’s precious resources? (Tory).

If the NHS is to improve, it needs to be funded at the level of other G7 countries (it’s currently bottom of the league) and it must stop wasting money on policies and treatments that are substandard or don’t have a good evidence-base. According to the best guess of NHS England, the NHS needs a funding increase of £30 billion over and above inflation by 2020-21, to cope with an ageing, frailer population. CEO Simon Stevens hopes that increased productivity and the efficiencies of ‘new care models’ will generate an extra £22 billion, leaving just £8 billion for the tax-payers and politician to fight over. The NHS has never in its history managed such productivity gains, and a far more likely scenario is that, with less money the NHS will just provide less service. The Tories and Lib Dems have pledged £8 billion, or an average real increase of just 1.1% a year. However, with no detail on where the money is coming from it could arrive too late to save the NHS, which is desperately short of cash now. Labour promises a one-off increase of £2.5bn a year over and above inflation now, but it may not be repeated if the tax on houses valued at over £2m doesn’t come good.

The most sensible plan for NHS funding comes from the National Health Action Party, who are fielding just 12 candidates (including 6 practising doctors) The NHAP manifesto proposes a 1p rise in basic rate of income tax to raise around £4.5 billion/year. It would scrap the market within the NHS, which also costs around £4.5bn a year to run. It would renegotiate PFI deals – hospital trusts currently spend £2bn/year on hugely over-priced repayments – and cut the cost of locums (£2.5bn/year) and management consultants (£ 640m/year). It would invest in disease prevention, impose stricter controls and taxes on tobacco, alcohol, sugar and unhealthy foods. It would integrate health and social care, and invest in social care to divert pressure from the NHS. It would use the purchasing power of the NHS to secure better deals on drugs and medical equipment. And it would try to crackdown on tax avoidance and evasion. It argues not just that a healthy NHS requires a healthy economy, but that the opposite is also true. Higher investment in healthcare stimulates economic growth, ensures a healthy workforce and encourages spending in local economies.

The NHAP is unlikely to win any seats but has received a lot of media exposure because its policies are more based on evidence than ideology. Perhaps the biggest lie of all in this election is the government’s claim that NHS bureaucracy has been reduced. The number of managers on the NHS payroll may have been cut, but the staggering complexity of the Health and Social Care Act, and all the new organizations that have to be involved in commissioning and contracting services in a healthcare market has meant vast amounts of time, money and outside support from management consultants and lawyers have been used to try to make sense of it all.

Any change to NHS services, such as transferring more care into the community or providing enhanced services in a GP practice now requires an absurd amount of paperwork and negotiation involving multiple organizations (e.g. CCGs, local area teams, NHS England, Public Health England). The NHS struggles enough getting the contracts right, but has no hope of ensuring that, say, services outsourced to for-profit providers will provide safe, high-quality, good value care1. It has enough trouble trying to ensure its own services are high quality in the current funding crisis. As the Health Service Journal reported, more than 80% of acute hospitals in England can’t meet their own targets for safe nurse staffing levels. That £4.5 billion a year currently wasted on turning the NHS into a market needs to go to the frontline, and soon.

My bidet revolution in the NHS, from the bottom up, is here