Manifesto pledges: more money for the NHS… problem solved?

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

Political parties' NHS funding promises

Data sources: NHS five year forward view, Conservative Party manifesto 2015, Labour Party manifesto 2015, Liberal Democrat Party manifesto

Gareth Iacobucci reports on the opinion of David Nicholson, former CEO of the English NHS. All main political parties’ pledges for NHS will prove inadequate, says former chief executive

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 …

Cartoons about creative problem solving, avoiding problems, taking action, avoidance, dealing with stress, stress management, avoiding stress.

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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