Funding for the Future – Where next for the NHS?

It is the debate that politicians on both sides of the House of Commons wish to avoid in the run-up to the 2015 general election; how do we continue to finance the NHS? The pressures on A&Es across the country are at their most severe and the healthcare system faces the challenge of an ageing population, but can a solution be found?

Since September 2010 the NHS’s budget has experienced a prolonged freeze, with further spending only rising at the rate of inflation and consequently NHS Trusts have had to make £20 billion worth of savings over the course of this parliament.

According to senior health sources the NHS in England now faces a funding gap of up to £2 billion, about 2% of its budget, for the next financial year. The issue for central government is that any additional savings in the NHS budget are few are far between and could potentially hinder frontline services and patient care. If the NHS is to maintain both a high standard of healthcare there either needs to be a reorganisation of currently provided services, or a substantial increase in its annual budget.

In a recent letter to The Times, leading health experts have called for a cross party, independent conversation on the way forward for the “scope, provision and funding of health and social care”. According to the signatories of this letter, including the heads of the Royal College of Physicians and Royal College of Nursing, the current system is ‘creaking at the seams’ and that there needs to be ‘an honest, open dialogue between politicians and citizens’.

This is unnerving territory for politicians, especially when options for future NHS funding include higher taxes, payments for some elements of healthcare, or a review into what is available on the NHS. Such initiatives will almost certainly meet with public hostility, although the avoidance of any debate only serves to place the NHS under even more financial strain; a situation in which the costs will be felt by patients.

It is therefore crucial that the result of any open dialogue between politicians and citizens identifies a funding system for the NHS that is both fair and viable in the long term. The option to charge the public for certain healthcare services is flawed in terms of fairness; even if low income households are exempted, middle income households will have to pay to access the same service. Payments for specific services are unlikely to be progressive, and therefore low middle income earners will potentially face the same costs as those on higher incomes.

Any policy that will charge the public to access specific healthcare needs is far less likely to be well received by voters than a slight increase in direct taxation. In a recent Guardian/ICM poll only 21 per cent of voters surveyed were in favour of charges, while 48 per cent preferred tax-funded increases in expenditure on the NHS.

Labour MP Frank Field advocates a slight increase in national insurance contributions, but any scheme must include ‘a total rethink of how the service is delivered around patient needs’. Therefore, aside from either increases in taxation or payments for certain treatments, any future NHS reforms must include investments in service redesign, incorporating how, where and when services are provided.

By Liam Stott

[Image Credit: Digital Cat]


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