Support those who think beyond clamour for more cash

The rattle of NHS begging bowls is reaching a crescendo. Every plea is a mixture of sound reasoning and self-interest. The acute sector is being robbed to bankroll the better care fund; clinical commissioning groups rue the diversion of funds to support specialised commissioning; and mental health sings its Cinderella song once again. The King’s Fund wraps it up all up by predicting an “inevitable” financial crisis for the NHS.

‘Simon Stevens realises that when he left as Tony Blair’s all-powerful health adviser in 2004 he left a job half done’

Among the health service tribes, general practice complains funding has collapsed, while the Francis-inspired demands for increased nurse-to-patient ratios mingle with the cry for more specialist doctors in the latest area exposed as delivering unacceptable variation in care. The unions, their patience strained, flex their muscles for action over pay restraint.

Meanwhile, exclusive polling shared with HSJ shows two-thirds of the public favour increased NHS funding to maintain current service provision.

Policymakers and manifesto writers are working hard on an answer to the conundrum of NHS funding. The trouble is, the one they are most likely to come up with would be a disaster for long term sustainability.

Finishing the job

It seems likely the NHS ringfence (perhaps including social care spending) will be maintained by whoever wins the next election. It is also probable that deficit reduction (at varying speeds) will continue to dominate Treasury thinking. As a result, health and social care will grow to an unprecedented proportion of public spending. The outrage of those going without in the public sector would be uncontainable.

‘The NHS needs no more unresourced sticking plasters. Neither will it benefit in the long run from “handouts”, however generous’

In that context it would be unsurprising if a government offered a series of relatively small one-off injections to tackle pressure points – as it did with emergency care last winter – or to calm whichever professional group was gaining the most traction. These interventions might even be bundled together into a much trumpeted “cash boost for the NHS” and presented as the government showing its commitment to free public healthcare.

This will simply be passing the buck. Funding of this nature and scope would see the NHS lurch from one capacity crunch to the next.

At last week’s Commons health committee NHS chief executive Simon Stevens revealed NHS England and others will produce a report on the NHS’s future which would be heavily informed by its financial outlook. Here is the plan of a man who realises that when he left as Tony Blair’s all-powerful health adviser in 2004 he left a job half done.

No more sticking plasters

The 2002 budget bonanza and the 10-year reform programme rightly identified repairing the damage of decades of underinvestment by boosting care and workforce capacity as the first priority. But the unfulfilled second half of the reforms were meant to see a wide range of changes, for example greater use of technology and commissioner driven service remodelling, which would have meant the NHS could better absorb the demands created by demographic and social trends.

‘We should support the policymakers who can quieten the clamour of the moment and focus on this long term goal’

To exaggerate to illustrate the point: the last decade was characterised by reforms that improved capacity but did little to make the service better able to meet changing demand; while the last few years have been dominated by ideas that focus on service change but leave many of the accompanying capacity questions unanswered.

The NHS needs no more unresourced sticking plasters. Neither will it benefit in the long run from “handouts”, however generous. It requires a well defined long term investment plan linked directly to a series of outcomes – some likely to challenge the status quo – which are directly aimed at improving the service’s responsiveness to the evolving nature of healthcare.

We should support the policymakers who can quieten the clamour of the moment and focus on this long term goal.