No one will admit what is facing the NHS – but the crisis isn’t over
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Version 0 of 1. The autumn statement, just a week ago, confirmed the genius of NHS boss Simon Stevens’ NHS Five Year Forward View. Swiftly subtitled by the media as how to save the NHS in 50 pages, it has framed the debate about the future of the health service since it was published in October. Its crisp, clear, sensible and more or less achievable solutions make it hard for politicians to duck and weave around the more money question. But it doesn’t settle the issue. Defining the problem, and describing how it might be tackled, is one thing. Making it happen is quite another. It would be a mistake to imagine the crisis is over. Without the Forward View, you can bet George Osborne would not have trailed the £2bn a year he pledged in the Commons last Wednesday. As it happens, it’s not quite as generous as it sounded, since £750m was recycled from elsewhere in the health budget. But even if it were a pot of all-new money, it is not clear that it would be enough to meet the familiar pressures of an aging population with multiple health problems, and the costly demands of new technology. At least on the Osborne projection, the new cash would be on-stream immediately. Labour plans to meet the cost of its pledge of £2.5bn a year partly from the proceeds of a mansion tax, which would not be in place until halfway through the next parliament. The Lib Dems promise just £1.5bn and want the catastrophically inadequate funding for mental health to take priority. The gritty, awkward detail and the political commitment to the NHS rarely seem to match. Even the Stevens’ report treads lightly on some of the difficulties. None of the independent health thinktanks believe that the 2-3% efficiency savings on which the sums depend can really be delivered. The Health Foundation reckons half that would be a more realistic assessment. According to the Forward View best forecast, a real-terms increase of 1.6% a year would set the NHS back on its feet. Hmm. With the new money, next year it will have had a 1.5% increase. And no one thinks it will be alright. The acute hospital sector is teetering on the edge of viability, condemned as “unsustainable” by the National Audit Office. The last five years of efficiency savings have been achieved partly by clamping down on NHS pay. But that is unsustainable and it has worsened the shortage of nurses. The perverse effect of it has been to inflate the bill for agency staff, which has soared from £3.5bn to £4.5bn in a single year. Social care budgets, beyond NHS control but exacerbating pressure on it, have been cut by 12% since 2010-11. Just propping up this fragile edifice could easily take all the new cash available without beginning to tackle the transformation that’s needed to make the NHS more efficient and more effective. At least healthcare will get more money whoever wins the election. But it cannot all go to patch up the existing service. Stevens says £450m will be diverted to a kind of transformation fund. Another £250m a year will be used to modernise primary care – £1bn over four years – and some of the remainder will be saved as an emergency fund to bail out floundering hospitals and commissioning groups. That means the next five years will see the NHS lurching, again, from crisis to crisis, says the Kings Fund. Only this time, each year will be worse than the last. On current projections, the 10 years from 2010 will be the most austere decade the NHS has ever endured. Everyone can see this coming, but no one is admitting what needs to be done. That needs a tangible commitment to developing new systems and running them in parallel with existing ones in order to save in the longer term. Instead, we are getting what amounts to a political bung to keep healthcare out of the headlines and down the political agenda. Failing to address the real problems can only erode public confidence – and strengthen the hand, in the longterm, of the politicians who, for ideological reasons, still view as incomprehensible the principle of a national health service. |