A rising chorus of voices seems to be calling for more funding to be given to the NHS in order to prevent a “crisis” – but should we be looking at more significant reforms instead?
New reports have argued for NHS funding to be increased again in order to avoid hitting a “crisis point” over the next few years. How much Britain spends on healthcare looks set to be a key political battleground during the run-up to the next general election in 2015. Yet is how much we spend on healthcare the real issue? In order to cope with our ageing population and the rising demands this places on healthcare services, it seems inevitable that tough choices will have to be made and new approaches will have to be found.
“Will something have to give?”
A slew of recent reports about the NHS seemed to have invoked the spectre of crisis to draw attention to its short-term funding constraints. These date back to the decision which was taken by the Coalition Government when it first came to power to make funding for the NHS one of the few forms of government expenditure they would maintain at current levels – although as both background inflation and patient demand have been rising, this still amounted to a cut in real terms.
Recently, senior figures from both the Conservatives and the Lib Dems have argued that the current funding arrangements are unsustainable. Former Liberal Democrat Health Minister Paul Burstow has warned that the needs an additional £15 billion over the next five years in order to function properly, without which it could be at risk of collapsing.
His concerns were echoed by Dr Sarah Wollaston, the Conservative chair of the Commons Health Select Committee, who told the BBC that the NHS was facing “crunch time.”
“So many more people are living with several long-term conditions and of course we have got amazing advances in technology and we need to be able to fund all those things. We know that over the next few years, we are going to run into a real crunch time with funding and what’s necessary now is for NHS England to set out very clearly what can be achieved within various funding limits. In other words – are we going to be able to increase funding, or will something have to give?”
This sense that the NHS is under immense pressure has been strengthened by some alarming details which have been gathered by The Guardian:
“In April the number of people waiting more than 18 weeks for an operation hit three million, a six-year high. In May the cancer treatment target was missed for the first time since it was introduced in 2009, and there was a record number of delayed discharges, where patients were kept in hospital often because of a lack of social care options in the community.
This month brought talk of a GP recruitment crisis, with figures showing a fall in the number of family doctors since the coalition came to power…Then last Friday official NHS data revealed that 299,031 patients had arrived at hospital A&E departments that week – the highest number on record. The A&E four-hour waiting time target was also missed for the 49th consecutive week. And all this with a £2bn shortfall discovered in the NHS budget for next year. ‘It’s basically a winter crisis in the NHS every day now,’ one senior hospital official told the Observer.”
Do we need a new approach?
Clearly, the NHS is facing enormous pressure. Yet can Britain simply afford to continue directing more and more money towards it, even as the population ages and changes in medical technology demand more and more investment?
This issue is especially important from an intergenerational perspective, as health and social care are services which are largely funded by the current generation of workers to look after patients who are mostly much older. On current trends, today’s workers will have to pay a vast amount in to the system to care for the ageing of the baby boomer generation – an elderly cohort of unprecedented size and longevity – a transfer which could threaten to stretch the intergenerational social contract to breaking-point.
Is there any alternative? Fortunately, new models for how we can fund health and social care on a sustainable footing appear to popping up everywhere at the moment. The highly-respected think tank The King’s Fund has launched the Barker Commission on the Future of Health and Social Care in England, chaired by the economist Kate Barker, which will publish its major policy proposals later this year. IF has submitted its own response to their call for evidence, which is available here:
Barker Commission – Intergenerational Foundation Response
Meanwhile, the promulgation of other radical proposals, such as the suggestion put forward by Reform (another think tank) that everyone should pay a hypothecated NHS tax, shows that an important debate does seem to be taking place. None of these suggestions is necessarily the right answer on its own, but it is vital for this debate to take place if we want to achieve the goal of providing a universal health service as the population ages and pressure on the NHS grows. The only question is, will those in power be open-minded enough to listen?