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Politicians agree on NHS problems – but differ on the solutions Politicians agree on NHS problems – but differ on the solutions
(34 minutes later)
The call this week by three former health ministers for a cross-party commission on the future of the NHS and social care is a sign of the growing desperation among the care services’ most passionate supporters that they are sinking into a crisis from which it will be difficult to escape.The call this week by three former health ministers for a cross-party commission on the future of the NHS and social care is a sign of the growing desperation among the care services’ most passionate supporters that they are sinking into a crisis from which it will be difficult to escape.
The proposal was made in parliament by Liberal Democrat former health minister Norman Lamb, and supported by Labour’s Alan Milburn and Conservative Stephen Dorrell – now chair of the NHS Confederation. It shows that there is convergence between the main political parties in terms of diagnosing the problems, but important ideological differences remain in the prescribed solutions. Could a consensus be emerging by the time of the next general election?The proposal was made in parliament by Liberal Democrat former health minister Norman Lamb, and supported by Labour’s Alan Milburn and Conservative Stephen Dorrell – now chair of the NHS Confederation. It shows that there is convergence between the main political parties in terms of diagnosing the problems, but important ideological differences remain in the prescribed solutions. Could a consensus be emerging by the time of the next general election?
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Although the chances of such an all-party approach at the current time are vanishingly small, it was attempted as recently as 2010, just before that year’s election. Lamb was one of the driving forces behind it. Then the brutal realities of electoral politics took over, and it soon collapsed in acrimony.Although the chances of such an all-party approach at the current time are vanishingly small, it was attempted as recently as 2010, just before that year’s election. Lamb was one of the driving forces behind it. Then the brutal realities of electoral politics took over, and it soon collapsed in acrimony.
But everyone is searching for a new way forward. The experiment of driving NHS quality and efficiency through wholesale competition between services, underpinned by patient choice, has delivered some improvements but has self-evidently failed to deliver the hoped-for transformation, while leaving many services struggling. Even the health secretary, Jeremy Hunt, has admitted that patient choice isn’t working.But everyone is searching for a new way forward. The experiment of driving NHS quality and efficiency through wholesale competition between services, underpinned by patient choice, has delivered some improvements but has self-evidently failed to deliver the hoped-for transformation, while leaving many services struggling. Even the health secretary, Jeremy Hunt, has admitted that patient choice isn’t working.
While competition has allowed some foundation trusts to become renowned centres of excellence, it has done nothing for the walking wounded such as Medway foundation trust – rated inadequate again this week – who continue to let down their local communities while going through a seemingly endless succession of interventions, firings and inspections.While competition has allowed some foundation trusts to become renowned centres of excellence, it has done nothing for the walking wounded such as Medway foundation trust – rated inadequate again this week – who continue to let down their local communities while going through a seemingly endless succession of interventions, firings and inspections.
The trusts at the bottom of the quality pile also demonstrate the impossibility of regulating our way to excellence. The new Care Quality Commission inspection teams can fill a train carriage, but the problems continue to multiply. So what’s next?The trusts at the bottom of the quality pile also demonstrate the impossibility of regulating our way to excellence. The new Care Quality Commission inspection teams can fill a train carriage, but the problems continue to multiply. So what’s next?
It is possible to foresee a time in the next few years when all the major parties would perceive a benefit in collaborating on finding a new financial settlement for health and care services. Irrespective of ideology, it is plain to everyone that NHS funding is bending the rest of the public spending programme out of shape while leaving the health service short of cash and social care vulnerable to the vagaries of the market, with the likelihood of more care home providers getting out.It is possible to foresee a time in the next few years when all the major parties would perceive a benefit in collaborating on finding a new financial settlement for health and care services. Irrespective of ideology, it is plain to everyone that NHS funding is bending the rest of the public spending programme out of shape while leaving the health service short of cash and social care vulnerable to the vagaries of the market, with the likelihood of more care home providers getting out.
At around 9% of GDP, spending on health in the UK is relatively modest compared with many OECD countries. Trying to get more money into the system through some top-up fee or insurance scheme would be politically poisonous wreck, the principle of free at the point of need and while probably still failing to provide the necessary long-term funding base. But some variation of a care tax could well be a viable solution.At around 9% of GDP, spending on health in the UK is relatively modest compared with many OECD countries. Trying to get more money into the system through some top-up fee or insurance scheme would be politically poisonous wreck, the principle of free at the point of need and while probably still failing to provide the necessary long-term funding base. But some variation of a care tax could well be a viable solution.
Related: Jeremy Hunt cannot escape responsibility for the NHS's mounting problems
It would be politically honest, transparent, fair and sustainable. Voters would be given real choices about how much they wanted to invest in health care, revenues would grow with the economy and there would be a reasonable degree of certainty about future funding.It would be politically honest, transparent, fair and sustainable. Voters would be given real choices about how much they wanted to invest in health care, revenues would grow with the economy and there would be a reasonable degree of certainty about future funding.
Crucially, it could also underpin a new settlement for social care. Ministers have been fortunate indeed that despite the severity of the social care cuts the repeated warnings of a crisis have not translated into electoral harm. But the government cannot postpone indefinitely a wider discussion of what sort of old age we want for ourselves and our families, what we are prepared to pay for it and where that money should come from.Crucially, it could also underpin a new settlement for social care. Ministers have been fortunate indeed that despite the severity of the social care cuts the repeated warnings of a crisis have not translated into electoral harm. But the government cannot postpone indefinitely a wider discussion of what sort of old age we want for ourselves and our families, what we are prepared to pay for it and where that money should come from.
Such a funding settlement would finally create the capacity to invest in prevention and community services, which everyone knows are the only long-term solution to spiralling hospital demand.Such a funding settlement would finally create the capacity to invest in prevention and community services, which everyone knows are the only long-term solution to spiralling hospital demand.
A new financial deal would still leave space for ideological differences about how the health service should be structured and run. The Conservatives are attracted to far stronger local accountability, while Labour instinctively sees this as a threat to the national character of the health service. But neither approach is going to work without a great deal more cash. They can all agree on that.A new financial deal would still leave space for ideological differences about how the health service should be structured and run. The Conservatives are attracted to far stronger local accountability, while Labour instinctively sees this as a threat to the national character of the health service. But neither approach is going to work without a great deal more cash. They can all agree on that.
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