The NHS needs more money, but can we afford it?

Christopher Hyland, 30 June 2014

The apposition of the words ‘crisis’ and ‘NHS’ is now so frequent that it is apt to become a cliché. Indeed, in the word-processing software of many subeditors, the phrase “NHS in Crisis as…” is automatically inserted into every headline.

And yet, there is good news! A recent Commonwealth Fund study has ranked the UK pre-eminent among 11 countries for the quality of its healthcare: the cue for much sententious ‘pride of Britain’ piffle from Owen Jones. “The only serious black mark against the NHS”, however, as the Guardian noted – rather sardonically, I thought – was “its poor record on keeping people alive”.

Ah. Well, yes. The question “Does it keep people alive?” is one that I would probably rank quite high were I making a survey of the efficacy of national healthcare systems. Nevertheless, the UK ranked top overall, and top in its ‘provision of effective care’, of ‘co-ordinated care’, and of ‘patient care’.

Let’s examine the efficacy of that care.

Without even mentioning mid-Staffordshire, or the announcement of yet another Francis report (this time into whistleblowing and the culture of secrecy in the NHS), three very serious sets of figures were released in the last fortnight, which must cast some doubt on the performance of the NHS:

• GP recruitment is at its lowest levels since 2007, and the number of GPs per 100,000 of the population has fallen by 2.6% since 2009. One in four people who visit A&E do so because they cannot see a GP.

• A full 10% of nurse posts are vacant, and in some of the most high-pressure and urgent departments: A&E, intensive care, and neonates. These also happen, by a gruesome coincidence, to be amongst the lowest paid specialties.

• A&E waiting-time targets have been missed for at least five consecutive weeks: a very serious indicator of trouble, since most A&E departments usually experience a spring lull as they recover from their annually unexpected winter crises. The government has promised a £400million cash injection – but this is an analgesic, not a cure.

For that reason, the head of the British Medical Association warned today that the NHS is “palpably fraying at the edges”. The simple explanation is that healthcare costs currently outstrip the available resources. Womb-to-tomb-healthcare is very expensive, and we are in a period of austerity. The former Conservative health secretary, Stephen Dorrell, has warned that the NHS is in danger of collapse within five years unless spending is increased.

However: since its foundation in 1948, NHS funding has risen by an average of 4% a year (p.15). The NHS was intended to consume 3% of the budget, and it has now grown to over 8%, with ever-increasing costs. It must make efficiency savings of £20billion by the end of this parliament – 2015 – or it simply will not be able to continue its normal functions. It looks unlikely to succeed, and, from the figures above, it seems that the quality of care, and access to it, is already suffering a decline.

Our tendency is to think that money is a panacea. But can we afford to increase NHS funding? And can we afford not to?