This article first appeared on the Guardian
The numbers are gobsmacking, when spelt out in today’s Guardian/King’s Fund research. They expose how much money is missing from the NHS. As our reports from the frontline reveal, the wonder is that the NHS continues to care brilliantly for most people most of the time, despite the missing billions.
If NHS spending simply level-pegged with our GDP, it would have £16bn more. We have fallen to 13th out of the original 15 EU states. But had we stayed at their average level, the NHS would be getting £43bn more, according to the King’s Fund’s chief economist, Professor John Appleby. Once sums get that big, it can be hard to grasp how transformative that would be.
In the winter crisis of 2000, Tony Blair promised to bring the UK up to the EU average – and Labour did. Its 7% rises saw the service measurably improve. But the NHS only reached that EU average briefly, before plunging down again.
The government hasn’t lied, or not quite. NHS funds have grown annually, but at just 0.9% a year for 10 years to 2020. It has never had so little. Since 1948 it has had an average 4% more a year, as numbers of the old rise, and expensive new technology and drugs save extra lives.
Public opinion, like the Daily Mail front page, wants everything to be available. Otherwise families run “save my child” campaigns to get treatment abroad: humiliating for a country proud of its health service.
The government’s riposte to the missing money is to say by 2020 it will give the NHS England chief, Simon Stevens, the £8bn he asked for. But he only dared ask only for what he knew he could get, not for anything like enough to cover mounting debt.
It is very nearly a lie to pretend the NHS is “ringfenced” when public health was hived off to local authorities, and immediately Osborne took £200m out of its budget. (Beware, councils going for Osborne’s NHS devolution: once it’s yours, he can snatch the cash back.)
Public health cuts mean addiction, sexual health and other services are closing, diverting more patients back to the NHS. What’s more, slabs of money are taken from the NHS to “share” with councils – mostly a failure.
If NHS funding is more or less static, why should we care if its a third less than the general rise in GDP? Partly because NHS costs and demands rise much faster, not slower, than GDP. But also because in the long term, relativity matters. GDP measures the general standard of living, and over time, as it rises, so do expectations in every aspect of our lives, including health.
Call the Midwife looks charming, but who wants the same death and injury rates to mothers and babies as back then? Relativity matters in everything. The poverty measurements the government is now abolishing show how far some fall behind median living standards, the only long term social gauge that makes sense.
NHS detractors warn that the service is a “bottomless pit”, yet all it needs is roughly the EU average, and for spending to rise with living standards. People are more willing to pay tax for the NHS than for any other service, as Gordon Brown found when he raised national insurance for the NHS – the most popular budget in years. An earmarked tax might be acceptable, but the Treasury hates the rigidity of hypothecated taxes – and unless all the NHS were paid for from one transparent tax, it would be almost impossible to pay for it in this way.
The Lib Dem former health minister Norman Lamb says the NHS and social care are “sleepwalking to disaster” and calls for a cross-party commission to examine what funding they need to join the services together. Care funding does need to be aligned with the NHS – difficult to do, when the better-off contribute to their care costs but not to NHS treatment.
To start a “national conversation”, Lamb has the former health secretaries Alan Milburn and Stephen Dorrell on board. He says that this “transcends party politics”, which of course it doesn’t, and never will, because this is the very essence of party politics.
In his interview with the Guardian this week, Simon Stevens was remarkably forthright. By 2018, he said, there must be a national consensus on “properly resourced and functioning social care services”.
He offered the politically dangerous but entirely correct solution: the old have benefited hugely from this government, so the money must come not from the struggling young families but from the property, pension pots and triple-locked pensions of the retired. That’s political dynamite.
As he calls for “radical change”, some inside the NHS express alarm at Lamb’s commission idea. His trio would inevitably want to come up with bright new ideas for funding: how dull to conclude the blindingly obvious – more cash from general taxation. They would inevitably rake over all the snake-oil remedies offered by anti-NHS forces advocating charges for GPs and hospital visits, means testing and top-up insurance.
In the present political climate, this government can do more or less what it likes, unopposed. Today’s King’s Fund figures are shocking. Our month-long series should be an eye-opener, both on how great the NHS is and how perilous is its condition.