Andy Burnham, Labour’s shadow health secretary, was scathing about George Osborne’s promise of further spending on the NHS in the Commons on 1 December. There is plenty to be scathing about: the crisis in mental health beds that at the weekend led to a 16 year old being detained in a police cell, the lengthening accident and emergency waiting times, missed cancer treatment targets and the difficulty in getting a GP appointment. And then there is the record number of elderly people who cannot go home because of the deep cuts in local council social care budgets, and the rising pressure those same cuts are piling on to emergency as well as hospital services.
These are all signs that despite the coalition’s promise to protect the NHS budget from cuts, there is just not enough money to meet the steeply rising demographic and technological pressures out of what is in effect a standstill budget. None of this is news, although that does not make it less important. It is why extra funds amounting to nearly £1bn have already been pumped into the NHS this year. But it underlines the great national question that has to be faced about meeting the cost of caring for an ageing population – and the real need for a serious, informed debate rather than the cheap point-scoring that it often seems none of the parties can resist.
By a wide margin, voters trust Labour more than the Tories with the NHS, which is why Andy Burnham ill-advisedly once talked about “weaponising” it. Equally, the Tories know they are vulnerable, and they also know that they, not Labour, are the party that voters trust with the economy. That is why a notably low-key Jeremy Hunt, the health secretary, made a strong economy the first of the four pillars on which the future NHS will depend in an wide-ranging statement that his colleague George Osborne will be hoping has silenced the debate at least until after the autumn statement.
At least all the parties are now willing to put a price tag on their support for the NHS: at the last election the promises were kept damagingly and misleadingly vague. This new transparency is not only because of soaring deficits at as many as three-quarters of NHS hospitals, although the obvious stress even before the first snow has fallen over England is alarming.
The more important explanation is Simon Stevens, the new boss of NHS England. Last month the one-time Blair government adviser coordinated a report charting the possible courses for the whole NHS with their likely cost, the contribution that efficiency savings could make - and the shortfall that government would have to find. The Five Year Forward View was intelligible, uncompromising and just about affordable. It was also agreed by all six of the bodies responsible for health care. It demanded political engagement.
Mr Stevens is a class political operator, as he showed last week giving evidence to MPs on the public accounts committee about the financial resilience of the NHS. His success in framing the debate was confirmed when it emerged this weekend that he and the chancellor met three times last week to discuss how much money was needed, where it would come from and how it would most effectively be spent. That direct contact is a novel development in itself, possibly one that may be hard for future health secretaries, left on the sidelines, to accommodate. But the structure created by the Health and Social Care Act, separating management from political accountability, has set up a rival power base, one that Mr Stevens has all the skills needed to exploit. The first result is clear – the scale of the challenge that any incoming government will face to fund the NHS over the next five years. More detailed analysis for the Nuffield Foundation suggests that even Mr Burnham’s £2.5bn year on year will barely hold spending per patient at its current level.
This is the hard fact that has to be confronted: the UK as a whole spends a smaller share of national income on its health service than other comparable countries in Europe. The NHS is highly safe and efficient – as international surveys repeatedly confirm. It therefore needs more money – but voters deserve an honest debate about how much, and where it is to come from.
