There can be little doubt that the NHS is struggling with rising demand. The system was never designed to cope with an ageing population and the associated long-term conditions. Treating the 30 per cent of the population with at least one long-term condition already takes up 70 per cent of the heath and care budget in England and this is set to increase.
Claims of an NHS “on the brink” and going through a “cash crisis” are however nothing new: there were frequent similar reports during the 2000s when the NHS budget doubled in real terms. During that period, most of the additional resources put into NHS went towards increased headcounts and higher pay. At the same time productivity, especially in hospitals, declined. Unless this is addressed, the Office for Budget Responsibility’s forecast of public sector debt reaching 234 per cent of GDP in 2066 starts to look optimistic.
For this reason, with more comprehensive reform firmly in the too difficult column, the next government must avoid the temptation to simply throw more money at the NHS and try to make the existing system work as well as possible.
The Sustainability and Transformation Plans, wrongly criticised in some quarters as “cuts”, offer a reason for optimism and must be pursued in the face of local opposition to closures of local units.
The government understands that there are too many hospitals in the UK and specialist care is better delivered at scale. For all the inevitable campaigns against local service closures, it is well known that patient outcomes are improved when there are a small number of major trauma centres as opposed to many smaller A&E units. Likewise, reducing the number of acute stroke centres in London from 32 to 8 has improved survival rates.
Reform of the NHS tariff system, which fails to reward innovation should also be pursued. Cases like that of the Liverpool surgeon who was prevented from using Skype to remotely show parents how to remove dressings from their children because the tariff for such a consultation was too low are typical.
Additionally, post-2019 the government should remove many regulations placed on the NHS by the European Working Time Directive (WTD). NHS Employers, the body which represents NHS trusts, claims amongst other things that the WTD has a negative impact on running costs, adversely impacts the training of junior doctors and reduces the quality of patient care.