General Election 2017: Time to get real about NHS funding

Fri 12 May 2017

In the first of a series of election posts, MiP chief executive Jon Restell calls on politicians of all parties to come up with credible plans for funding the NHS.

In this election campaign MiP is asking candidates from all parties to make four simple commitments to the NHS in England: to fund the NHS and social care properly, to switch resources to where they’re most needed, to support the NHS workforce and to support managers in the NHS. I’ll be setting out our position in a series of four blogposts over the course of the campaign.

In this first post, I want to talk about funding. There’s no escaping this question. It’s hard to find anyone outside government circles who thinks the NHS has enough money to deliver what we expect from it.

Healthcare experts, like the King’s Fund and the Health Foundation, agree that existing spending plans for the NHS are simply not credible. The distinguished House of Lords committee looking into the sustainability of the NHS recently concluded that “the Government needs to set out plans to increase health funding to match growing and foreseeable financial pressures more realistically”.

Even the government’s own spending watchdog, the Office for Budget Responsibility, thinks it’s inevitable that we’ll need to spend a bigger slice of our GDP on healthcare – and has pencilled that into its long-term projections.

Of course, MiP members and other NHS staff know this already. They work up close and personal with the effects of underfunding: longer waiting times, targets being missed all year round, a GP service in crisis and social care and community health services under unsustainable pressure.

Managers working to make the NHS more efficient and implement the Five Year Forward View (5YFV) know we need up-front investment in change programmes and stable long-term funding. And they can see the chasm between how the 5YFV says the NHS should be made more efficient and what is happening on the ground.

The 5YFV says we should “take action on prevention, invest in new care models, sustain social care services, and over time see a bigger share of efficiency coming from wider system improvements”.

The reality is almost the exact opposite: public health funding has been slashed. There’s little or no money to invest in integration or realising the potential of STPs. Social care services are falling apart. Efficiencies, such as they are, are coming from making managers and other support staff unemployed, freezing staff pay and squeezing budgets for hospitals, primary care and community services.

MiP members are acutely aware of the crisis in social care and its impact on the NHS. The squeeze on social care budgets is unprecedented – total spending has fallen by 17% since 2010 and we now spend less than 1% of GDP on this vital service. The results are clear: 26% fewer people are now getting free social care than in 2010.

This is so important that, at last year’s MiP conference, members overwhelmingly supported the idea that any new money available this year should go into social care rather than the NHS itself.

NHS managers know too that long-term care of the elderly is a ticking time-bomb under the whole health and care system. We simply have to do something about this. And that means serious and credible plans. For example, a tax on estates is one option we believe should be considered as a way to fund social care in the long-term.

So what are we asking for from the political parties at this election?

Firstly, we think the UK should raise its spending on healthcare to same levels as comparable European countries like France and Germany. That means increasing our healthcare spending from 9.8% of GDP to around 11% by 2022. That would give us around £23bn to invest in reforming our health and care services for the 21st century.

Secondly, the NHS needs a stable funding regime, so we believe future governments should commit to increasing health spending in line with increases in GDP. As the economy grows, the NHS budget should grow with it.

Thirdly, we want to end the Cinderella treatment of social care services in the UK. Plugging the funding gap in social care will be the number one priority for the new government. And future governments should commit to increasing social care spending in line with spending on the NHS.

Finally, we are calling on all political parties to work together on a long-term plan for funding elderly care. This issue cannot be kicked into the long grass. If politicians don’t like the so-called “death tax”, let’s hear their alternatives, agree a way forward and take action before it’s too late. 

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