I am the only one fed up to the back teeth about the 5 Year Forward View and how everyone is supposed to spell out how they would fund it?
To start with it is not a plan in any sense just a few principles that nobody other than possibly Lansley would disagree with. It says much of what everyone else is saying and so in general there is a sense of agreement – but it’s superficial.
Rightly Andy Burnham is cautious – saying that he agrees with the principles, like better investment towards prevention, but is not prepared to somehow back the “plan” with a promise of money.
The 5 Year Forward View represents the views of those with the strongest vested interest in keeping things as they are. It glosses over the existence of the H&SC Act and all that implies for enforced competition and a remorseless rise in the share of services provided by the private sector. It fails to do the impossible which is to square the claims that GPs as commissioners lead in designing services when they are constrained by the compulsory competitive tendering the Act brought in.
And the 5 Year Forward View does nothing to address the issue of accountability. With a market system as brought in by H&SC Act you don’t need to talk about accountability as the market decides. What the SHA campaigns for is a proper mix of representative and direct accountability. The View on all this is obscure to say the least. It also says not much of anything about the shift to shared decision making and the key role for community development – the real challenge for the future.
And worst of all it continues to look just at the NHS as if it existed as a separate island isolated from the rest of our public services. Again that is what you would expect from those with the vested interests in the status quo. But it’s a huge blind spot – we have to look at a care system as a whole and look at it as part of the whole of the public sector – no longer an island.
So what about the £8bn then? This is the figure dreamed up by the proponents of the 5 Year Forward View to be the gap in 5 years time. The gap between what it will cost to provide the NHS (if long term historical trends over demand growth continue) compared to what will be available to fund it, if funding only rises in line with inflation – less a spurious and not credible allowance of £22bn for the productivity improvements.
The media and health commentariat treat this £8bn as if it was a solid fact, like the number of hospitals in Reading, but it is about as factual as the £10bn savings some claim will come from ending the market – it’s based on the taste of wet seaweed. If the NHS is great at anything it is at getting horribly wrong its projections about costs and demand. Oh and there is nothing about the workforce planning to underpin any plan.
So Labour is right not to be drawn on this bogus £8bn long term funding nonsense.
What we have is a crisis now. A crisis brought about by inadequate funding based on ludicrous and not attainable assumptions about productivity improvements (a theme emerging here). A gap this year of around £2bn filled by smoke and mirrors, and dire warnings of financial problems in 15/16.
Labour has identified additional funding of £2.5bn on top of the £2bn already promised. This might just about see the NHS through the next 12 – 24 months without melt down, let us all cross our fingers, but only if they take tough decisions to stop doing lots of things which may be worthy but which just get in the way of getting stability back into providing good care.
Actually it won’t be enough as social care is on its knees, so we will need more than the £2.5bn – soon.
After that – who knows? Claims and counter claims about what may or may not save money or cost extra.
So here is the real plan.
Use the extra money and find a bit more to restore stability and improve morale. Stop doing things which just make delivering care on the front line harder. Invest in the staff and fund more and better training and development.
Get rid of the market nonsense and make it clear beyond doubt that commissioners (or whatever we call them in the new world) are free to arrange service how they see fit, so long as the follow the preferred provider approach. Make it also clear that providers can cooperate, share services, reach agreements and generally cooperate without any external market intervention. Stop looking at organisation and pretending they are competing and delivering a sustainable surplus; look at localities and how well they are delivering care.
Then the money.
Well maybe we should have a proper study done. Let’s set one up and invite contributions from all who agree on the key principles of a tax funded free at point of need care system, predominantly publicly delivered and democratically accountable. The aim would be to reach a consensus amongst the progressive elements on how to fund care into the future. Do it openly and transparently if agreement is reached use it to feed into the next public spending round.
I think that the bogus £8bn will turn out to be something else.