The Guardian view on the NHS settlement: a good compromise, but not a generous one There will still be a double dip in health standards without co-payments and overt rationing:
The chancellor listened, or he gave in, depending on your prejudice. What matters is that nearly half of the £8bn of new money promised to NHS England over the next five years will come now, and that is a victory of sorts for Simon Stevens, its chief executive. Mr Stevens had played a high-stakes game in his negotiations with the Treasury, setting out five tests for the spending review and, with an appearance on BBC Question Time scheduled for Thursday, making it clear he would be ready and willing to comment on the record about the settlement George Osborne will announce in full on Wednesday.
But by any reckoning, only the first of the five Stevens tests – the one about front-loading the £8bn to fund the development of new models of care – has been met. And what looks like a windfall has to stretch to cover more surgical procedures and cancer treatments as well as underwriting the government’s manifesto pledge for a seven-day NHS by the end of the parliament. On top of that is the matter of a £2.2bn deficit.
Rather than meeting Mr Stevens’ demand for more money for public health, some of it will come from cutting public health investment, an absurd quick fix that can only produce higher spending not far down the road. As for the all-important funding of social care, shortage of which is already damaging hospitals’ ability to meet their targets, there is no light ahead. The new mantra for NHS reconfiguration is “place-based systems of care”, an idea that is intended to cut through the notorious NHS silo approach and bring different providers together. But the intensifying battle over the Better Care Fund, which diverts NHS cash to support new models of social care intended to reduce demand on hospitals, shows what conflicted territory this is.
Mr Stevens’ commitment to putting NHS funding on a sustainable footing was hard enough to meet before the shape of funding for the next five years was clear. The extra £8bn was always a very tough objective. It continues a period which has seen the smallest percentage increases in spending since the 1950s, shrinking health as a share of GDP just as it rises across the developed world. There are always savings to be made, and assets like old hospital sites that can sensibly be realised. But in the end, demand from an ageing population and new drugs and technologies, is rising inexorably. Very soon, a chancellor will have to acknowledge that the biggest users of the NHS are also the demographic most privileged in the tax and benefits system – the elderly. And it may make more sense to give them less in cash in order to make sure that health and social care is there for them and everyone else who needs it.