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The Progressive Policy Think Tank

More money for health and care? Yes, but we need reform too

“Somebody has to have the guts to admit the system is broken. Until they do that, nothing will change.” These were the words of John Sibley, whose 89-year-old mother Iris had been waiting six months in hospital for a place in a nursing home when he gave a newspaper interview last year.

It was the wrong environment for an elderly woman who, with the proper social care, could have been discharged from the Bristol Royal Infirmary into more suitable surroundings. “In the hospital there is nothing,” Mr Sibley told the Independent in February 2017. “They are wonderful people, and they do the best they can – but my mum was in a hospital, not in a place where she could call home.”

Not only was the experience distressing for Iris and her family, but it also cost the NHS more than £80,000 to accommodate her for six months.

There has been much talk about pumping more money into the NHS recently, with Jeremy Hunt revealing that Theresa May will give a “significant” cash boost and long-term funding settlement as the organisation’s 70th birthday present. But whilst Hunt has been pushing for annual increases in funding as close to 4 per cent as possible (the long-run level before 2010), the Treasury claims that more than 2.5 per cent is unaffordable. The interim report of Lord Darzi’s Review of Health and Care, published in April this year, revealed that Hunt is much closer to the mark. With Britain’s growing and ageing population, the NHS is under increasing strain. Without extra funding, it will be unable to continue providing quality patient care. As a result, whichever way you cut it, more money is needed.

But it’s not just a question of how much money we need – it’s where we get it from. Since 2010, the government has funded increases in NHS budgets by cutting other public spending. This is patently a false economy. A wide range of public services shape our health, from education about healthy lifestyles to environmental action on air quality. In cutting the very services that underpin our health, we are sacrificing long-term stability for a short-term patch up.

The elephant in the room is social care. Since the backlash against the proposed ‘dementia tax’ in the Conservatives’ 2017 election manifesto, the government has fallen silent on funding for the NHS’s sibling service. But ignoring the problem is not sustainable. As our population ages, care is becoming ever more important. There is little point pouring money into the NHS whilst social care starves. Bed blocking – epitomised by Iris’s story – has tripled in the just six years to 2016, leading to worse patient care and higher costs.

Instead of cutting and neglecting other public services, extra money for the NHS – and social care - must be funded from increased taxes. Critics might complain that this is unpopular and politically infeasible. But research by The King’s Fund shows that 61 per cent of the public are in favour of paying more tax to properly fund the NHS. A struggling health service with operations cancelled, spiralling waiting times and patients left on trolleys in hospital corridors is hardly popular or politically feasible, either. If the government rules out tax increases, it is guilty not only of denial but of negligence.

But, money alone cannot be the answer. The constantly changing nature of the disease burden, scientific capabilities and technological innovation require us to be ambitious. To stand still is to fall back. We must embrace a 21st century health and care system which means reform must sit at the heart of any funding plan for the NHS.

Recently, the Labour Party announced that it would bring in reforms to undo the structural changes set out in 2012 by then health secretary, Andrew Lansley, which it claims are ‘unfit for purpose’. There is undoubtedly truth to this: the legacy of the Lansley reforms is fragmentation and a lack of clear accountability. Structural reform is unpopular but it may also be necessary. However, reform must mean more than structures. Politicians must instead embrace the two main levers that will shape the NHS in 21st century: tech and talent.

Tech and big data have transformed every aspect of our lives, from how we buy our groceries, to how we work - and how we date. But it is yet to transform our health services. Joined-up online patient records, available to all clinicians, would be a simple and transformative first step. It would avoid the current situation whereby patients are required repeat their stories again and again as they use different NHS services. We also need to make the most of developments in AI and robotics to enable automation of administrative tasks, giving healthcare workers more time to care for patients rather than filling out forms. This could produce savings of up to £12.5bn a year of staff time for them to spend on interacting and caring for patients.  

We also need to invest in the talent of the team. We have only survived the last decade of austerity through the dedication of doctors and nurses across the country, working above and beyond to care for patients despite a pay freeze and increased workload. But morale is at an all-time low and many healthcare workers are at breaking point. Two in five GPs are planning to quit within five years, and the number of unfilled nursing posts has doubled over just four years. The government’s decision to scrap the public pay cap is an excellent step forward, but the suggested increases are well below private sector growth and inflation. This removes incentives for talented workers to join the team and erodes morale. The government must commit to training more staff across the NHS, and embrace immigration as a way to fill staffing gaps in the meantime.

Earlier this month, Jeremy Hunt became the longest-serving health secretary in British history, overtaking Margaret Thatcher’s health secretary Norman Fowler as well as Aneurin Bevan (who established the NHS in 1948). He marked his five years and 273 days in office with his declaration that the prime minister had agreed to a “significant” funding increase. Successfully making the case for more money for the NHS, after eight years of austerity, would be an honourable achievement. But unless he also reverses the fragmentation created by Lansley’s reforms and also invests in the tech and talent of the NHS, the nation’s most beloved public service will struggle to get off life-support.

Mary Reader is a Research Assistant at IPPR. She tweets @reader_mary