John Appleby of the Nuffield Trust opines in the Guardian 19th December: The Tories’ NHS pledges only scrath the surface of a deep crisis. The plans to be outlined in the Queen’s speech won’t solve problems such as low staffing and long waiting times
But who listens to experts these days?
The NHS was a dominant theme in the 2019 general election campaign, from harrowing pictures of a child being treated on an A&E floor to fears over the impact of a trade deal with the United States.
Performance statistics released during the campaign showed the number of people waiting too long in A&E departments was at its highest level on record – in October, far from the depths of winter. Reflecting this and the poor state of staffing and buildings, public concern about the service rivals even Brexit.
While their campaign focus was Brexit, the Conservatives also pledged more money and more staff for the NHS as a response to these issues. But with major problems facing the service, they will now need to go beyond these promises if they are to turn the situation around before they face voters again.
Today we are expecting an NHS bill in the Queen’s speech, which will pledge to increase the annual day-to-day health service budget by £34bn by 2023-24. This is largely the same as the figure of £20.5bn pledged by Theresa May in 2018, without adjusting for inflation. But either way, it represents a sharp break from the years of austerity, bringing spending back to what has been the historic norm, and giving the service room to breathe again.
So far, we have seen no concrete plans beyond next year for the so-called “capital” budget, which the NHS needs to invest in buildings and equipment. The Conservatives have pledged 40 new hospitals alongside 20 upgrades in the coming years. This will require substantial investment over and above current levels of capital spending. The cost for the backlog of repairs alone has now reached more than £6bn, resulting in dilapidated wards and broken infrastructure. In addition, the UK has the lowest level of CT and MRI scanners of any comparable country.
We should look for at least a five-year plan for this capital investment – and if the new government wants to rule for the long term, it could consider giving even more stability by planning a full decade in advance for both day-to-day running costs and capital investment.
The NHS also faces a dire staffing crisis, with a nursing shortage of 40,000 in England and a decline in the number of GPs per person for the first time in 50 years. The government’s promises of 50,000 extra nurses, 6,000 extra GPs and other staff will be difficult to deliver.
We have argued that the NHS needs those extra 50,000 nurses in the coming five years. But when we crunched the numbers with the King’s Fund and Health Foundation, we found that training and retention could not reach that figure fast enough – not even with nursing bursaries brought back to attract students. That kind of increase would require immigration, on a larger scale than the Conservative figures assume. In social care, again, migration will be an indispensable support to a system that already has massive staffing shortages and yet is likely to need even more.
Earlier migration crackdowns on people from outside the EU caused a sharp slowdown in the number of staff from overseas, and there is a real risk that any post-Brexit crackdown will have a similar effect. The Conservatives have promised to soften the impact with “NHS visas” for doctors and nurses. But they should rethink any policy that results in a drop in staff migration.
Social care, meanwhile, is a failing system. Repeated cuts have meant many people who need help go without, and the unlucky minority who need most care often end up facing ruinous private bills.
Despite years of commissions and promises to unveil solutions in government, the winning manifesto avoided any solutions. But the options are straightforward and well understood. We can look to Germany or Japan for state-run insurance systems, to Scotland for at least partially tax-funded care, or to the cap system passed into law under David Cameron but still postponed. With the largest majority in 15 years, the time for action is now.
Topping the public’s list of concerns, meanwhile, is the issue of spiralling waiting times – fed by every one of these deeper problems. Addressing funding and staffing should soften the pressure but make no mistake, the issue will take years to solve.
The Conservative manifesto was relatively silent on particular commitments to address waiting times. Both Cameron and Tony Blair once hoped that greater competition and outsourcing to the private sector would increase efficiency and operations. But this government seems to have no similar plan: if anything, the legislative proposals on the table for the NHS would reduce the marketisation by taking away requirements to put contracts out to the market.
In the past, driving down waiting times has taken management focus, particular tactics and a willingness to make it a priority, even if it means not every shiny new thing is affordable. Will we see this again?
If the new government wants the state of the NHS to be a favourable reflection on it in the next general election, it must start taking serious action now.
• John Appleby is director of research and chief economist at the Nuffield Trust
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