NHS funding matters because you get what you pay for. The level of funding has a key role in defining how well we can care for patients, how many staff we can employ, the drugs we can afford and the innovations we can adopt. So it’s no wonder that the debate on future NHS funding has been one of the main features of the general election. But there remain five vital questions that none of the campaigns have answered.
Most of the focus has been on whether the parties will sign up to the £8bn of extra funding the NHS says it needs in its Five Year Forward View and how this will be paid for. What’s missing is that the Five Year Forward View set out a £30bn funding gap by 2020 with only £8bn of the £30bn coming from extra taxpayer funding. The other £22bn is intended to come from NHS efficiencies.
The £22bn question
1. That £22bn has received only a tiny fraction of public attention. Many in the NHS, including the key independent thinktanks, believe the £22bn will be very difficult to realise and that, while the mantra of integrating health and social care will be better for patients is often repeated, there is no evidence that integration actually saves quick and large amounts of money. So the first question is can the NHS really save £22bn through proven cash releasing efficiencies and, if so, what are these? Without an answer to that, any extra taxpayer funding won’t go very far.
When will the money arrive?
2. The profile and timing of any extra taxpayer funding. Adding £8bn by 2020, once the deficit has been eliminated, or adding £2.5bn by 2017/18, once new taxes have been created, are all very well, but they won’t solve the large and immediate financial problem facing those who have to deliver care to patients today. Some 80% of England’s hospitals and 50% of all provider trusts are in deficit. In the last financial year, the overall provider sector deficit was around £900m and this year it will rise to £2bn-£2.5bn. So how are the parties going to phase any extra funding, with particular emphasis on the funding for this and the next financial year?
Where is the money going to go?
3. General election campaigns are often about retail politics – guaranteed GP appointments, dedicated personal midwives and the like. Yet none of the desirable offers made so far such as seven-day services, 36,000 more NHS staff and additional mental health services are costed in the existing NHS plans and, most importantly, its budgets. If the NHS needs £8bn in taxpayer funding to close the gap on existing service levels, then new initiatives will need additional funding on top. How much of the extra funding being pledged is to pay for these service improvements and how much is to plug the existing gap?
Innovation isn’t free
4. Funding transformation. All the political parties, rightly, support the Five Year Forward View’s vision to transform how the NHS delivers care. But change costs money – £2bn a year over five years according to one estimate. How and to what extent will the parties fund the transformation that they, and we all, say is essential?
How much are staff worth?
5. NHS foundation trusts and trusts spend between 65% and 85% of their budgets on staff pay. So if we are to realise efficiencies, we have to either cut or make better use of that pay bill. Yet there seems to be an arms race on raising NHS staff numbers. This is simply not credible financially or from a staff supply perspective since the extra staff do not exist and are not yet trained. The NHS has already added an extra £1bn-£1.5bn of unfunded staff cost over the past two years that it cannot afford – hence the ballooning provider sector deficit. So how do the political parties’ promises on staff numbers match up to the NHS’s financial needs and the availability of people with the appropriate training and skills?
That’s not all
And, of course, these five questions ignore the longer-term issues flagged up in studies like the Barker report – the need to raise overall NHS and social care funding longer term and ensure full integration between the two systems.
Our members tell us that they do not believe the current election campaign faces up to the scale of the problem the NHS faces and that none of the pledges will alter the grim reality of the service’s fast-crumbling finances. More realism and honesty please.
