Mrs May’s money will make no difference and will not create trained staff. If she admitted there would be no dividend for at least 10 years she would be more honest.
What if she buys more scanners – where are the radiologists to report and where are the radiographers to provide, and the oncologists to define the treatment, and radiotherapists to treat?
Where is the plant to provide the projected radiotherapy needs?
So how will the money be raised, and how will it be spent, and over what time horizon does the government expect results?
….”to secure the NHS’s future not just over five years, but another 70, it needs a full check-up, rather than just a ten-minute trip to the GP. And we need similar long-term thinking on its funding.”
Without this no administration can win the hearts and minds of the professionals who man the system. They know the truth, which is that there has to be rationing; by exclusion, restriction, exception, reduction, prioritisation, etc. What we don’t like is unpredictable post-code rationing which differs for different people with the same condition.
Weeks — months — of furious speculation, and it all boiled down to a simple set of numbers. Would the settlement be closer to 3 per cent or 4 per cent? For five years or ten? Could Theresa May hit the magic figure of £350 million a week? Would Philip Hammond even let her?
Finally, we have some clarity. The NHS will receive, as its 70th birthday present, a real-terms annual funding increase of roughly 3.4 per cent. Not as much as some wanted, but more than many feared. And though it is being billed as a “Brexit dividend”, the prime minister ominously admits that “as a country” — by which she means as individual taxpayers, present and future — “we need to contribute a bit more”.
What has been almost completely buried in the coverage of this story, and was certainly overshadowed in her interview on The Andrew Marr Show yesterday, is an equally important aspect of the prime minister’s announcement: her insistence that the money must be spent wisely.
It’s often said that analysts at the Commonwealth Fund consider the NHS the world’s best healthcare system. It’s less often said that it actually came 10th out of 11 nations in terms of “healthcare outcomes” — in other words, the most important bit. Compared with its rivals, the NHS has far too many deaths from strokes and heart attacks, and our closest peers in terms of survival after a cancer diagnosis are Chile and Poland.
As the debate over the funding settlement reached its height, we at the Centre for Policy Studies carried out some simple analysis. It showed that as NHS funding goes up, productivity tends to go down: in other words, it does more with less, and less with more. The most notorious example of this was the great Blair/Brown splurge, which was, as the prime minister points out, misspent to a quite scandalous degree.
It’s not just about the headline figures. Talk to anyone in the NHS and you will come away with a laundry list of complaints about how the service works: the profusion of quangos; the targets and funding mechanisms that often incentivise, or force, people to act in the wrong ways; the fact that it is still far too hard to reward and replicate good performance, both by trusts and individuals, and punish bad.
This is why Mrs May was right to insist that the new five-year budget settlement — itself a welcome injection of certainty — be accompanied by performance improvements. That NHS leaders will be held to account for how it is spent, that the health service will have to become more efficient. That structural issues such as slow adoption of new technology and the disconnect between health and social care must be addressed.
But there is still a limit to what this government, or any government, can do. That is why the prime minister, as the NHS turns 70, should appoint a cross-party royal commission: taking NHS England’s current plan as its starting point, but going beyond that to deliver a full examination of the health service and how it can improve.
The difference between an NHS that matches its best productivity performance over the coming decade, and one that lives down to its worst, is vastly greater — in terms of patients seen, operations carried out and lives saved — than between the prospective funding settlements.
In other words, to secure the NHS’s future not just over five years, but another 70, it needs a full check-up, rather than just a ten-minute trip to the GP. And we need similar long-term thinking on its funding.
We will not know until the budget how the new cash will be found (though freezes to tax thresholds are rumoured). But economic growth of 1.5 per cent and NHS spending growth of 3.4 per cent is not a circle that can be squared for ever, unless we either want the state to amputate many of its other functions or to end up paying far more tax: approximately £1,000 extra per individual taxpayer by the end of the decade. (Remember: just as voters complain about the NHS, they complain equally bitterly about the pressure on their pockets.)
Yet if you suggest that part of the answer could be to find ways to deliver extra funding to the NHS outside of general taxation — from charging for missed appointments to introducing top-up payments to get more money from richer patients — you are castigated as a heretic. This, again, is an area where a royal commission could make progress, without the usual party-political brickbats.
The humbug that often surrounds the NHS has a real cost because it stops the health service working as well as it could or should. A few days ago, for example, the head of a left-wing think tank grandly tweeted that “the #NHS is as much a social movement as it is a health system”.
But the NHS is a health system, one that all of us rely on. Yes, it’s packed with dedicated staff, many doing impossibly difficult jobs for little money. But sinking into a sepia-tinted, Danny Boyle reverie about #OurNHS and the #TirelessAngels within it is not the way to make it better. Nor is thinking of all of its problems in terms of how much cheapskate politicians put in, rather than what the rest of us get out.
Robert Colvile is director of the Centre for Policy Studies