John Appleby from the Kings Fund opines: Manifesto pledges: more money for the NHS… problem solved? (BMJ 25th April and Kings fund) Everyone knows that overt rationing could solve the problem, but honest discussion is tactfully avoided in the most dishonest election, full of lies and half truths.
As Ipsos MORI has been reporting for some months now, the NHS is a big issue for the public, and now nearly half of all Britons surveyed (47 per cent) say the NHS and health care is their top concern when deciding how they’ll vote in the general election. The public’s concerns have been reflected in the political parties’ manifesto promises – a combination of more money and a long shopping list for how the extra cash will be spent (more doctors, more nurses…24/7 motherhood, and a free prescription for apple pie). But what do the promises add up to, and is the NHS safe in anyone’s hands? (And why is the politician’s favourite number 8,000,000,000?)
The manifestos’ focus on how much money should be spent on the NHS has been driven by a future funding scenario described by NHS England, Monitor, and other national NHS organisations in their joint forward look at how the NHS might fare over the next five years. Predicated on some upfront investment in infrastructure and operating investment (that is, keeping the business going), NHS England estimates that although the NHS needs a funding increase of £30 billion (€42 billion; $45 billion) over and above inflation by 2020/21, it could increase productivity by 2 per cent a year over the next few years and then by 3 per cent a year as the new ‘care models’ come on stream. In effect, this generates the equivalent spending power of £22 billion, leaving just £8 billion to be funded by the taxpayer. To get to such a real increase will require a cash increase of nearly £23 billion.
While there is nothing in the NHS national bodies’ Forward View that details the evidence or science behind the productivity assumptions (and hence the figure of £8 billion), both the Conservative and Liberal Democrat parties have signed up to NHS England’s funding scenario (Figure 1). This amounts to an average real increase of 1.1 per cent a year – similar to the increase over the last parliament. However, there is a lack of clarity about the Conservative promise, which could amount to a bit more than £8 billion depending on the period the pledge covers. Importantly, with no details on the path the Conservatives will take to reach their promise, there is a worry that the bulk of the increase could come in the later rather than (as needed) earlier years of the next parliament…..
Political parties’ NHS funding promises
The NHS faces a “substantial financial problem” this year that will require significant upfront investment to maintain current services, the former chief executive of the NHS in England has warned.
David Nicholson, who led the service from 2006 to 2014, said that it would be “helpful” for the NHS if Labour joined the Conservatives and Liberal Democrats in committing to his successor Simon Stevens’s call for an additional £8bn (€11.1bn; $11.8bn) of funding above inflation by 2020.
But he said that the current pledges from all main political parties would prove inadequate …