Plan B – Be Afraid

NHS Funding Social Care

Five years ago the SHA was raising awareness about the dangers posed to our NHS by the emerging Lansley proposals – which many at that time appeared to support.

The Lansley project has failed but the desire of powerful elites to end the ‘socialist’ NHS – free at the point of need and funded from taxation – has not gone away.  Plan B is emerging.

In fact Plan B is not new.  It goes back to the previous Tory strategy of causing the perception that the NHS is failing and then using that to argue that the old NHS model does not work.  You can hear the messages about how despite ring fenced funding, despite additional £billions, despite record levels of investment and reductions in management costs, the NHS can’t deliver efficiency.  It just sucks up extra funding but fails to deliver a decent 24/7 service.  Bolshie doctors and unionised staff are protecting their own vested interests and blocking progress; bureaucratic inefficiencies persist as services are never subjected to proper competition with the much more efficient private sector.  You can hear these messages already – expect more.

Most of the Lansley ideas have been quietly dropped; doctors are not in charge, autonomy is vanishing (bail outs are conditional on compliance), top down management by shouting is back, more targets and terror than competition, politicians are interfering.

The greatest danger now is the lack of adequate funding.  The illusion being created is that with a little extra funding and huge efficiency gains all will be well.  The reality is that our model for the NHS is not sustainable without greater funding a) for the NHS itself to maintain standards, b) to invest in the necessary new models of care and c) to dramatically improve the shamefully poor social care system.

So we who wish to defend our NHS may need a new Plan as well.  We might also recognise that the messages around the NHS being sold off, death by privatisation and 24 hours to save our NHS did not make much impression on the electorate.

So our task is to convince the public, especially the voting public, of a few simple truths:-

A tax funded single payer NHS based on need is efficient and effective and morally right – it should be the model we apply to social care as well.

The NHS we now have – tax funded, universal and comprehensive – which the vast majority support, is significantly underfunded.  The major gains in funding levels (in terms of £ per head or of % of GDP) achieved under Labour have been reversed.   And this will eventually lead to deterioration in care and restrictions on access.

So taxation will have to increase.

We can concede that the care system can be more efficient and cost effective (and this is always true) but there are no magic solutions; grand reforms and major reorganisations simply do not work.  The whole language of ‘reform’ has been devalued into oblivion.

And the care system is poorly adapted to the modern requirements especially to support those with long term conditions and multiple morbidities. Lack of integration leads to many poor experiences of care.  The NHS is not well aligned with the rest of our public services.

But greater efficiency in providing care; better allocation of resources and a more integrated system will not deliver anything like enough ‘savings’ to offset the growth in demand.

So the inevitable conclusion is that taxation will have to increase.

Simple messages:-

  • Our NHS model – universal, comprehensive and tax funded is the best model there is
  • It should be extended to all care
  • We need a long term funding solution that increases the share of GDP spent in the care system
  • Progressive taxation is the fairest way to pay for care
  • Our care system should be integrated but not through top down structural reorganisation or massive legislative changes
  • There are efficiency gains to be made but privatisation and outsourcing are rarely efficient
  • There can be improvements in outcomes and in the experience of care but privatisation and outsourcing are not the solution.

If we can get these messages over then we can combat the Tory argument that it is the NHS model that has failed and not simply that the right model is being destroyed by cynical underfunding.