Jeremy Hunt has considerably heightened expectations for the so called birthday present for the NHS later this month telling us to expect ‘significant’ investment.
We know the NHS is experiencing the biggest financial squeeze in its history and on current projections the Conservatives are breaking their manifesto promise for real terms head for head rises every year of the Parliament.
Public health and training budgets have been cut, and the capital budgets raided with the consequence we have a £5billion backlog for repairs.
NHS Trusts ended 2017/18 with a deficit of £960million; £464million above the plan set for the year and £196million worse than last year.
The NHS has failed to meet its constitutional standards. The 18 week list has grown to four million, and 2.5million have waited longer than 4 hours in an A&E.
It’s clear our NHS and social care sector needs a long term plan – it’s what I’ve been calling for since I became the shadow health secretary in 2016.
We’re told a plan is imminent. But I’m struck by the world of difference between what is happening today and the way a long term plan was last put in place by the Labour government in 2002. Seventeen years ago Gordon Brown tasked Derek Wanless with conducting a comprehensive analysis of the future health needs of the country and the options for funding it. It was a detailed, exacting piece of research conducted over around year.
Based on that in-depth analysis Gordon Brown introduced a specific and sustainable tax increase for the NHS – not hypothecation. That investment was tied to modernisation to tackle waiting lists and rapidly expand NHS capacity. It culminated in some of the lowest waiting lists and highest satisfaction ratings.
And it all began as a thorough, detailed process ran by the Treasury not hindered by it.
I don’t think the same can be said today.
That legacy has been systematically unravelled since Labour left government beginning with the Lansley reforms which should have been stopped in their tracks by Jeremy Hunt but weren’t with disastrous consequences for all concerned.
So how should we judge what the government propose in the coming weeks? I would like to offer five tests.
First, the funding test. Labour’s commitment is a fully funded NHS and social care service to fulfil the obligations to the public legally enshrined in the NHS Constitution and to improve the quality of care for the future.
Our plan involved nearly £9billion extra for health and social care in the first year of a Labour government paid for by fair increases in taxation – this would amount to more than a 5% increase immediately.
We would ask the top 5% to pay more in income tax, increase taxation on private medical insurance and increase Corporation Tax. Given our long term commitment is to a fully funded NHS and we would establish an OBR-style process to advise us on funding needs for the future.
But how will the government fund its NHS commitments? Will this government increase borrowing, cut more deeply into other areas of public services or propose unfair tax increases?
So our first test is to whether the government are prepared to take fair decisions on taxation to fully fund our NHS and public social care including allocating a 5% increase immediately for the NHS.
Secondly, on staffing. We have a vacancy gap across the NHS of 100,000 including for more than 40,000 nurses and midwives, 11,000 doctors, 12,000 nursing support staff and 11,000 scientific, technical and therapeutic staff. Numbers of community nurses, mental health nurses and learning disability nurses have all fallen since 2010. And last week Jeremy Hunt conceded he’s failing on GP recruitment too.
The IFS-Health Foundation’s report predict we will be short of 170,000 nurses and 70,000 doctors in the future and with respect to social care the IFS suggests a massive 458,000 additional staff will be needed by 2033-34.
A credible plan to deliver the staff our NHS and social care sector need will be a key test of the government’s plan starting with bringing back the training bursary for nurses and allied health professionals and immediately dropping Theresa May’s restrictive ‘hostile environment’ visa regime, currently denying so many hospitals access to the very best international clinical staff.
Our third test is on the way in which care is delivered. By 2020 the population of over 65s will grow to 15.4million, and the number of over-85s will double.
As we live longer the disease burden changes too and health and care services increasingly must respond to the complexity of conditions we all live with.
And yet the current NHS landscape created by the 2012 Health and Social Care Act has delivered a fragmented wasteful mess – ‘an organisational no man’s land’ with ‘structures not fit for purpose’ as Alan Milburn recently said.
When faced with demographic changes and the need to help people manage long term conditions like diabetes we should consolidate not fragment. Health care should be delivered not on the basis of markets but on partnership and planning. Yet these structures have allowed a situation where NHS expenditure on private health providers now stands at £9billion.
So our third test is as to whether the government will scrap the Health and Social Act, end fragmentation, end privatisation and instead move towards genuine integration, planning and partnership, publicly administered and provided.
This week I revealed our NHS relies on decades old medical equipment, often in use long past its replacement date. In fact our NHS is still using nearly 12,000 fax machines costing thousands to administer every year. Investment in technology and innovation for the future is desperately needed. But after years of Tory austerity, our NHS is struggling to keep up with the present.
Our NHS faces a repair bill of £5billion and capital budgets have been repeatedly raided to fund day to day spending. What’s more we have some of the lowest numbers of CT and MRI scanners in the world and across the whole NHS we need better digital support too.
Over the coming years Artificial Intelligence, bespoke nutrition, robotics, digital health technologies, the internet of things – where 50billion devices will be connected in the next 25 years – will all offer huge opportunities for improving health outcomes in the future.
On current plans Labour would invest at least an extra £10billion in the infrastructure of our NHS, we would expand R&D investment across the board by £1.3billion during the first two years of the next Labour Government and to support the spread and adoption of innovation we would increase funding for the Academic Health Sciences Network.
So our fourth test is whether the government will sufficiently invest in the infrastructure of our NHS, renew existing equipment and ensure we access the innovative technologies of the future while banning capital to revenue transfers like we have seen in recent years that have led to such an unsustainable backlog of repairs.
Finally on health inequalities it should shame us as a society that advances in life expectancy have begun to stall and in some of the very poorest areas are going backwards.
Child poverty is on the increase and we know there is a correlation between poverty, deprivation and relatively poor child health outcomes.
So an overarching strategy to tackling the wider social determinants of poor health and wellbeing is our final test.
That means measures to improve the quality of air we breathe and the standards of housing many live in.
That means an all-out mission to improve the health and wellbeing of every child, starting with tackling the childhood obesity crisis through bold measures such as banning the advertising of junk food on family TV. And it means expanding not cutting public health and early years provision too.
The NHS and social care stands at a critical juncture.
In this 70th year of the NHS the Health Secretary has a chance to reset the trajectory of the last eight years.
My fear is that the 70th anniversary is being treated by ministers as the next public relations obstacle to be overcome by this troubled government, not as an opportunity for long term sustainable reform.
There has been no equivalent process to the Wanless report. Instead all we have are reports of a fudge being wearily negotiated between a beleaguered health secretary, an unimaginative chancellor and a powerless prime minister.
First published in the Huffington Post