Wednesday 19 February 2014

The only thing wider than the NHS funding gap is the policy vacuum

The only thing wider than the NHS funding gap is the policy vacuum You might have thought a £30bn shortfall in NHS finances would have prompted Jeremy Hunt into action. Apparently not.


Several recent reports have made two basic facts about the NHS impossible to ignore. One is that on current spending plans, the NHS will run out of money within the next 5 to 6 years. The other is that the Health and Social Care Act 2012 has created a dysfunctional set of structures which mask the government's failure to offer a credible response.

The Nuffield Trust has shown that because of population growth, ageing and cost increases, by 2020-21 the NHS will require some £30bn (25%) more than it is getting now just to maintain services at their present level – yet the government plans to keep NHS spending constant. Either services will be severely reduced or quality will deteriorate drastically or, more likely, both.

The Institute for Fiscal Studies' latest analysis goes even further: it now thinks that keeping NHS spending constant is likely to mean some other government departments facing spending cuts of up to 20%. But that is not going to happen. So unless budget plans are scrapped, NHS spending will have to be cut: services would then not just contract, they would disappear and quality would collapse. As Roy Lilley, an commentator, puts it in his widely read blog for NHS managers, it would mean the "extinction" of state-funded healthcare for all.

Yet the government has so far not proposed a credible policy response. Jeremy Hunt is momentarily protected by the legal fiction that he is no longer responsible for "providing" the NHS. Indeed, just before Christmas, in an extraordinary move, the chairs of both NHS England and the Care Quality Commission publicly criticised him for "meddling".

As a result, there is a policy vacuum, which the private health lobby is eagerly seeking to fill withrenewed calls for charging and "top-ups"; in reality, these would do little to close the funding gap, but would mean the end of free and equal care for all. In the meantime, it seems that in official circles it is left to everyone except Hunt to suggest solutions: more "efficiency savings" (Sir David Nicholson); rationalisation, with fewer hospitals offering specialist care (Sir Malcom Grant); more specialist GPs and intermediate care provision (NHS England's Dr Martin McShane); more self-care (NHS clinical commissioners); more telemedicine (the joint government-industry 3millionlives project).

But even taken together, these unproven and sometimes implausible ideas don't match the scale of the funding gap; and meanwhile the "reformed" NHS is bogged down in contradictions that make even good ideas unlikely to work. The Commons health committee favours"reconfiguration" (closing many hospitals and shifting resources to non-hospital and social care) but thinks it can't happen efficiently without decisions made in Westminster and implemented from Whitehall. But in England, key decisions on reconfiguration are being left to 130 cash-starved local councils and 211 clinical commissioning groups which were not designed to implement radical changes and lack the capacity to do so.

As for rationalisation, when two hospitals in Bournemouth and Poole proposed last year a merger to rationalise their services, the Competition Commission prohibited it; and plans to move the world-famous Papworth hospital to the biomedical campus at Cambridge are being blocked by the Treasury, which wants it to shore up Peterborough hospital's PFI-stricken finances by moving there instead. By these standards, government policy on flood prevention is a model of rationality.

Yet the government will eventually be held responsible for what happens to our healthcare. Flooding affecting many thousands of people has finally produced an irresistible demand for a policy response. A major crisis in health care will affect everyone in the country except the very rich. Is it acceptable for the secretary of state for health to have a sign on his desk saying, "the buck stops somewhere else"? The Guardian

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