Britain’s health and social systems are both struggling to cope with the pressures they are under, a point which is constantly being emphasised by an almost endless succession of negative news stories and policy reports. However, while the issue of the short-term crisis facing the NHS and social care has risen much further up the public agenda, there still seems to be a lack of long-term thinking about the NHS’s future; in particular, how the system could be redesigned in ways that will help it to avoid suffering more crises in the future.
Looking at the long-term sustainability of the NHS and social care was the daunting challenge which the eponymous House of Lords Select Committee was established to address. They have recently published their first report, which diagnoses a number of areas where the services will have to change in order to remain sustainable in the future.
Lack of vision
In summary, the report criticised the way in which the NHS and social care have traditionally been run as lacking a long-term vision. Lord Patel, the chairman, argued that the politicisation of these services has got in the way of effective policy-making:
“There is a shocking lack of long-term strategic planning in the NHS. This short sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions.”
The committee’s most radical recommendation was that the government should establish a new, politically independent body – an Office for Health and Care Sustainability – whose job it would be to make projections about the future healthcare needs of the population over a 15–20 year timescale. The idea is that this would become a trusted source of independent analysis which would be useful in holding the government to account, in a similar way to how the Office for Budget Responsibility (OBR) produces long-term economic projections.
The other recommendation the committee made which is likely to be contentious among politicians was that the NHS is simply going to have to receive more money over the years ahead. Specifically, they called for NHS spending to rise at least as fast as GDP for 10 years after 2020, reversing the period of austerity which it is currently enduring.
Interestingly, the committee also argued that the health and social care systems need to be more integrated, but they proposed that this should be done through greater centralisation – by making the Department of Health responsible for the budgets for both systems – which would almost certainly go against the move in both fields for greater place-based planning around local services.
Would politicians let go?
The diagnosis that excessive politicisation harms the quality of health and social care in Britain and prevents a proper national debate about these issues is surely correct. The committee proposes that health and social care should be depoliticised by establishing a cross-party national convention on the future of health and social care, so that all parties can take joint responsibility for the system.
Would any politicians be willing to do that, though? Health is a crucial issue for voters: it tends to come right at the top when opinion polls ask people to name the areas of government policy that they are most concerned about. And there are strong ideological divisions over what the future direction of government policy should be: the Conservatives have traditionally favoured introducing more internal competition within the NHS, while it’s hard to imagine Labour under Jeremy Corbyn would be willing to go along with that. Meanwhile, voters probably like feeling they know who to blame when things go wrong with the NHS and social care systems, even if it flies in the face of good policy-making.