Both Labour and the Conservative pledges on the NHS announced recently amount to continued hardship and austerity in the face of record demands for services and increasing reliance on for-profit services, often in such a way that the public cannot readily discern the role private healthcare providers play – or the cash they take out of the NHS. ‘More’ is not the same as ‘enough’.
In all the noise generated by the pledges, claims and counterclaims of the current election campaign, there has been an unwillingness amongst political hopefuls to discuss the baseline spending plans agreed by the last parliament and which would appear to be accepted by the main political parties. The impact of these, over the next 5 years will be grim, particularly for areas that are not ‘protected’, including local government (which includes social care), but also ‘protected’ budgets such as the NHS.
All the talk of ‘record funding’ conveniently ignores the fact that an increase in overall population and the rapid change in the age-structure of that population means that there is also record demand for services. Per capita expenditure has been falling and has trailed that of similar nations in the OECD for most of the past decade. Capital investment in trained staff, buildings and equipment has been particularly lacking and pillaged to support the day to day running of existing services.
In this context, the recent analysis by the Nuffield Trust provides a sobering backdrop.
When combined with the funding squeeze already baked in, the promised limited increase in spending on the NHS will represent a further prolonged period of severe austerity.
Under these circumstances, we need to make sure that every pound of funding is spent as effectively as possible. We need to start by questioning the constant flow of funding out of the NHS through outsourced contracts with commercial companies. Research commissioned by We Own It estimates this to amount to £10 million per week since 2012.
To this needs to be added the cost of setting up and monitoring these contracts and the rigidity they impose on the delivery of clinical services. If we are talking about reform of the NHS, we could do a lot worse than ditching the wasteful experiment in exposing the NHS to a rigged market system and returning it to a publicly provided service whose sole priority is the care of the people of this country. There is greater awareness that our buses, trains, water services and so many other essential elements of life need to be run as public services. For-profit health services have hidden behind the NHS logo for long enough.
Colin Hutchinson
DFNHS Chair
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