NHS funding: Waiting on white smoke

Source: NHE May/June 2018

Niall Dickson, chief executive of the NHS Confederation, makes the case for an integrated health and social care funding settlement.

For too long the NHS has been funded by what amounts to annual bailouts. It has had to rely on short-term, inadequate injections with no strategic underpinning, which have left the service significantly underfunded to deliver what is required. That is why the prime minister’s recent pledge for a multi-year settlement has been a welcome, and overdue, game-changer.

After a hugely challenging winter, which illustrated all too clearly the workforce and funding shortfall, there is now at least the prospect that we will be able to agree  a plan that links money to performance and seriously considers the longer-term requirements for both health and care services.

The Public Accounts Committee concluded in March that the national bodies charged with running the NHS “are too focused on propping up the system and balancing the books in the short term and have not paid enough attention to transforming and improving patient services.” A new settlement would give us all the opportunity to look ahead.

Alongside this, there is growing evidence that the public are now more willing to pay higher taxes to support the NHS. In the British Social Attitudes survey, 61% of respondents said they would support tax rises to increase NHS funding – that is 21% higher than in 2014. Recent polls have also indicated that, for many, the NHS is the number one issue of the moment – seen as more important even than Brexit. To that extent, the conditions are right for the government to act.

But before we all hang out the bunting, a word of caution. We do not know whether ministers will have the courage to provide the level of settlement that will be needed; we do not know whether the settlement will tackle the existing shortfall as well as the major issues that will arise from future demand; and we do not know if or how they will address the knotty issue of social care funding.

The latter point must not be forgotten. In   a recent poll of our members, 85% said they supported a long-term funding settlement for both health and care. They were unequivocal that both systems needed to be included, not least because of the pressures that are put on the NHS wherever social care is unable to meet demand.

A set of principles set out by the Department of Health and Social Care (DHSC) ahead of the social care green paper – due out later this year – recognises the need to ensure a sustainable financial system for care and, importantly, the need to have a debate with the public on the challenges of sourcing additional funding. But we have yet to see white smoke emerging on any of this from the new DHSC headquarters in Westminster.

The NHS Confederation has commissioned the Institute for Fiscal Studies and the Health Foundation to conduct a comprehensive study into the funding needs of the UK’s health and care systems for the next 15 years. The work – due to be published next month – is designed to provide objective evidence of what will be needed going forward. We hope this report will provide valuable input to inform the ongoing discussions in government about the amounts required for a settlement.

But this is not just about the government or indeed the centre coming up with more resources; that is necessary, but not sufficient. We also need an agreement which sets out what we will provide in return for that investment with clear and realistic goals over the next 10 years. And it will be essential that such a plan is not just cooked up in Whitehall, but involves the service as a whole.

We will continue to make the case for an integrated settlement on health and social care. Such a settlement, linked to a radical, ambitious and forward-looking plan, would be the best present for the NHS in its 70th birthday year.


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