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Guardian Live | How do we pay for the NHS we want? Guardian Live | How do we pay for the NHS we want?
(35 minutes later)
7.49pm GMT
19:49
‘Insurance’ klaxon. Nobody in the Guardian agrees with him on it, say Christopher Smallwood, but his concern is that the NHS does not have enough money and as we go forward standards are going to erode.
Tax revenues are not being produced quickly enough to make up what is needed to meet financial pressures, “So the question is where does that money comes from.”
“There is a problem that it should come from tax revenues and it should all remain free.”
The result? If we are going to be finance out of tax revenues the increasing demands on health taxes will have to “rise and rise and rise.”
“I don’t think any political party is going to find that an appealing pitch to the electorate. Therefore if we want to finance the health service properly we have to be open minded enough to think if there are other alternative ways of financing it.”
Just look across the channel, he adds.
7.42pm GMT
19:42
Charlesworth is optimistic about the NHS in 10 years. The health system is not a broken model, she says, even if we spend a lot on the free-at-point-of-delivery model.
“Assuming that we get economic growth, then we should have enough to spend more on it if we choose to do so. The problem is how we get from here to there. That’s obviously a political challenge, and it’s dependent on all of us wanting to spend more and agreeing how to spend more.”
Findings from the British Social Attitudes Survey pointed to “rock solid” support for the NHS as a free-at-point-of-delivery model. However, most people also felt that the NHS wasted money, and this feeling was particularly strong among those who had more contact with the service.
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7.39pm GMT
19:39
One of the challenges here is that doing the right thing for “health” might not be the same thing as doing the right thing for “healthcare”, says Anita Charlesworth.
Giving an example of what she says is a positive development, she says that the rate of teenage pregnancy has fallen. However, she links this to developments in education. “This has to be holistic. One of the things is that you get more plaudits from raising the healthcare budget, but you get rather fewer plaudits by raising other budgets that may help.”
Loneliness is going to be a major challenge in the years to come, she adds, but again, it may not be the healthcare budget that addresses it.
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7.32pm GMT
19:32
We have inherited a commitment that the NHS should be tax-funded and free at the point of delivery, says Stephen Dorrell. Rather than promoting and sustaining the ability of people to lead healthy lives, this means that the service ends up being focused largely on treatment.
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7.29pm GMT
19:29
The discussion moves on to international comparisons. A story we published today on that issue was the third most read piece on the Guardian site today.
Anita Charlesworth says that undoubtedly the NHS does very well in the measurements of the Commonwealth Fund.
However, we are bottom of the tables in terms of obesity and poor diet, which is a major driver of many of the poor outcomes, she adds. The OECD, she says, also notes that the NHS is quite a low spender.
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7.26pm GMT
19:26
Stephen Dorrell says that what the CQC has been doing is to focus on a local health economy and the experience of care for those living in that community, rather than a “tick box” system of the past.
7.23pm GMT
19:23
Declining health standards are a certainty over the next few years in the current circumstances, says Smallwood. “It comes down to more money,” he adds.
Christopher Smallwood: we are exploiting the professionalism and dedication of people to save money #ThisIsTheNHS
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7.21pm GMT
19:21
Anita Charlesworth says that what Britain is trying to do is make sure that it does not spend any more per head of population in health in 2020 than it did in 2010. She adds: “What we are trying to do in 10 years is not spend any more money, once we have allowed for inflation. We have never done that before. No other country has done it either.”
Christopher Smallwood says that so many hospitals are in deficit that finance comes to dominate every consideration. “You leave vacancies unfilled, you relax the nurse patient ratios,” he says.
“And most importantly, capital spending virtually stops. But you need it because it’s spending on x-ray machines, wards and so much else. If you do not invest in these things, then the whole system runs down.”
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7.15pm GMT
19:15
Stephen Dorrell says that at a time when the economy is in recovery mode, planning on the basis that the public service will compete in a market where prices are uncompetitive just does not work.
In terms of staffing, he says that it should not just be about bringing people in through the door, but also about creating an environment which is conducive to keeping people. Public sector pay policy is broadly sustainable, he adds.
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7.14pm GMT7.14pm GMT
19:1419:14
How do we keep nurses in the system? Polly Toynbee says that many are going because of the unbearable hours. How do we keep nurses in the system? Polly Toynbee says that many are leaving because of the unbearable hours.
She adds: “It isn’t just the money. You just needs lots more of them. And of course we are draining poorer countries of their doctors and nurses, which is not a very good thing either.”She adds: “It isn’t just the money. You just needs lots more of them. And of course we are draining poorer countries of their doctors and nurses, which is not a very good thing either.”
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7.12pm GMT7.12pm GMT
19:1219:12
“What’s the morale like in Tooting?” asks Paul Johnson.“What’s the morale like in Tooting?” asks Paul Johnson.
St George’s University Hospitals NHS Foundation Trust chair Christopher Smallwood says that it varies a lot.St George’s University Hospitals NHS Foundation Trust chair Christopher Smallwood says that it varies a lot.
In a way, he sees the doctors dispute as not so much about the individual items but through the prism of a bridge too far.In a way, he sees the doctors dispute as not so much about the individual items but through the prism of a bridge too far.
He adds, about low recruitment of nurses, that there has been a haemorrhage of staff.He adds, about low recruitment of nurses, that there has been a haemorrhage of staff.
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7.09pm GMT7.09pm GMT
19:0919:09
Anita Charlesworth opens up the debate by addressing the background to the latest doctor’s strike Anita Charlesworth opens the debate by addressing the background to the latest doctor’s strike. We’re facing another five years of very tight funding more broadly, she says, and expectations are that wages will pick up. However, morale has been rock bottom in the NHS, which she says should be a number one priority.
We’re facing another five years of very tight funding more broadly, she says, and expectations are that wages will pick up. “One of the things that has been driving overspends is the reliance on agency staff,” she adds, to murmurs from many in the audience. “You need people who are feeling positive … whether or not we can bring staff with us will be a deal-breaker in the next few years.”
However, morale has been rock bottom in the NHS, which she says should be a number one priorit. Updated
“One of the things that has beeb driving overspends is the reliance on agency staff,” she adds, to murmurs from many in the audience. at 7.23pm GMT
“You need people who are feeling positive.. whether or not we can bring staff with us will be a deal breaker in the next few years.”
7.07pm GMT7.07pm GMT
19:0719:07
Introducing the debate Paul Johnson says that much reporting of the NHS has been done in a reflex way, and so the Guardian’s series has been a concerted attempt to tell the story of the service through the voices of those who work in the service and are touched by it. Introducing the debate, Paul Johnson says that much reporting of the NHS has been done in a reflex way, and so the Guardian’s series has been a concerted attempt to tell the story of the service through the voices of those who work in the service and are touched by it.
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7.02pm GMT7.02pm GMT
19:0219:02
How do we pay for the NHS we want?How do we pay for the NHS we want?
Welcome to live coverage of a debate that seeks to provide answers to that question as part of the Guardian’s This is the NHS series, which has sought to tell the story of the service through the voices of those on the frontline.Welcome to live coverage of a debate that seeks to provide answers to that question as part of the Guardian’s This is the NHS series, which has sought to tell the story of the service through the voices of those on the frontline.
The debate, which is being chaired at the Guardian by the Guardian’s deputy editor, Paul Johnson, brings together:The debate, which is being chaired at the Guardian by the Guardian’s deputy editor, Paul Johnson, brings together:
“Health and high quality care for all, now and for future generations,” announces NHS England as its mission statement. Few would disagree with this vision, yet the reality of funding an ever sprawling NHS is increasingly the focus of heated political debate.“Health and high quality care for all, now and for future generations,” announces NHS England as its mission statement. Few would disagree with this vision, yet the reality of funding an ever sprawling NHS is increasingly the focus of heated political debate.
With NHS England boss Simon Stevens expected to make £20b in efficiency savings by 2020 and the UK falling behind Finland and Slovenia in terms of healthcare spend, how will the NHS continue to strive for and deliver high-quality care? With NHS England boss Simon Stevens expected to make £20bn in efficiency savings by 2020 and the UK falling behind Finland and Slovenia in terms of healthcare spend, how will the NHS continue to strive for and deliver high-quality care?
John Appleby of the Kings Fund warns that Britain’s status as an increasingly low spender might mean that the NHS cannot deliver improvements in the quality of care that patients want. John Appleby of the Kings Fund warns that Britain’s status as an increasingly low spender” might mean the NHS cannot deliver improvements in quality of care patients want.
The ageing population and a creaking social care system reeling from local council cuts are putting even more pressure on NHS resources and frontline staff. The aging population and a creaking social care system reeling from local council cuts is putting even more pressure on NHS resources and frontline staff.
Is it time for radical rethink of the way we pay for the care we expect? Our panel of experts debate their vision for the future. Is it time for radical rethink of how we pay for the care we expect? Our panel of experts debate their vision for the future.
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6.57pm GMT6.57pm GMT
18:5718:57
We’ve also been comparing the systems in some of the world’s leading countries for healthcare to examine who gets the best value for money, and who the best outcomes.We’ve also been comparing the systems in some of the world’s leading countries for healthcare to examine who gets the best value for money, and who the best outcomes.
Read on here:Read on here:
Related: Which country has the world's best healthcare system?Related: Which country has the world's best healthcare system?
6.57pm GMT6.57pm GMT
18:5718:57
Before the debate gets under way, here’s a report by health editor Sarah Boseley that goes to the heart of some of the issues being discussed.Before the debate gets under way, here’s a report by health editor Sarah Boseley that goes to the heart of some of the issues being discussed.
She’s been speaking to a leading expert on international health systems who says that, while the NHS has been the envy of the world for its fairness, good outcomes and value for money, it needs more funds and the dismantling of recent changes if it is to be so again.She’s been speaking to a leading expert on international health systems who says that, while the NHS has been the envy of the world for its fairness, good outcomes and value for money, it needs more funds and the dismantling of recent changes if it is to be so again.
Healthcare in the UK still takes first place in the rankings of 11 wealthy nations put together by the Commonwealth Fund in the US. But Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, says the real glory days of the NHS were in the 1980s. Other countries, such as Spain, Italy and Portugal, modelled their own systems on it.Healthcare in the UK still takes first place in the rankings of 11 wealthy nations put together by the Commonwealth Fund in the US. But Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, says the real glory days of the NHS were in the 1980s. Other countries, such as Spain, Italy and Portugal, modelled their own systems on it.
“The NHS was envied because it was very effective, low cost, and delivered good outcomes,” he said. But it was always underfunded. “It needs more money and it needs to dismantle some of the more recent changes,” he said.“The NHS was envied because it was very effective, low cost, and delivered good outcomes,” he said. But it was always underfunded. “It needs more money and it needs to dismantle some of the more recent changes,” he said.
PFI – the private finance initiative, which was used to raise money to build new hospitals – has left a huge legacy of debt. The financial troubles of the Barts trust in London, heading for a £135m deficit, the largest in NHS history, are largely a result of PFI, said McKee. That, together with the reorganisation imposed by the Health and Social Care Act and issues around the pay and performance of the workforce including junior doctors, had created “a perfect storm”, he said.PFI – the private finance initiative, which was used to raise money to build new hospitals – has left a huge legacy of debt. The financial troubles of the Barts trust in London, heading for a £135m deficit, the largest in NHS history, are largely a result of PFI, said McKee. That, together with the reorganisation imposed by the Health and Social Care Act and issues around the pay and performance of the workforce including junior doctors, had created “a perfect storm”, he said.
Here’s the article in full:Here’s the article in full:
Related: NHS needs funding rise to make it envy of world again, says healthcare expertRelated: NHS needs funding rise to make it envy of world again, says healthcare expert
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