Another week, another dreadful story about patients suffering at the hands of our increasingly cash-strapped NHS and care system. This time it was Iris Sibley, an 89-year-old woman kept isolated on a hospital ward for six months, despite being well enough to be discharged, because of a failure to find a suitable nursing home place. The result: not just huge financial expense for the NHS, but great human cost in distress and anxiety for Iris and her family.
The NHS’s alarm bells have been trilling furiously for months. Nine out of 10 hospital trusts have experienced overcrowding this winter, and the number of people facing long waits of more than 18 weeks for routine – often pain-relieving – care, has doubled in the last four years. Cynics are deploying the NHS’s current woes to argue the cherished principle at its heart – free care at the point of delivery based not on ability to pay, but on clinical need – makes for inefficient and unsustainable healthcare. Nothing could be further from the truth: one study rated it the top-performing healthcare system out of a group of countries that included Germany, France and Canada, despite costing less per head than all but one in that group.
What we are seeing is the direct result of our health service being starved of the financial resources it needs to maintain existing levels of care to an ageing population. The government has imposed the tightest funding squeeze the NHS has faced in its 70-year history. Little surprise, then, that hospital trusts in England ended the year with a record deficit triple the size of the previous year’s. The NHS’s problems have been compounded by cuts to social care: council spending on social care has fallen by 11% on average since 2010. Less state spending on social care means older people languishing on hospital wards when they are fit to be discharged, at great damage to their physical and mental health, and to NHS finances. More cash is not the only ingredient needed for the delivery of world-class care.
The NHS needs reform and modernisation to respond to changing needs, with more care delivered in the community for people living with long-term conditions, and more specialist acute care delivered in bigger centres. But deliberately depriving the NHS of the resources it needs makes this even more difficult. Local NHS leaders in England have been charged with transforming the delivery of care in their areas over the next five years to make it fit for the future. There are examples of real innovation, such as Manchester’s ambitious efforts to bring together health and social care in one budget. Yet, forced to find immediate savings, the process has inevitably become more about cutting back than about modernisation.
The government’s response has been shameful. Health secretary Jeremy Hunt continues to insist the English NHS has been given the resources it asked for, despite the health select committee pointing out the dodgy financial engineering involved in this claim. Even worse, he has sought to deflect from the funding crisis by launching an offensive against overseas patients, despite the fact that pre-charging them for elective care would raise only a tiny sliver of the NHS’s annual budget. This dog-whistle politics is all the more revolting given the NHS’s reliance on its migrant workforce.
There is a growing consensus our health and care systems urgently need more cash to see them through the next few years. Those calls are not being heard by a prime minister who warily regards the NHS as a bottomless drain on resources, and has prioritised tax cuts for businesses and more affluent families over spending on public services. Yet public affection for the NHS leaves ample room for leeway: back in 2002, Gordon Brown achieved the unthinkable – a popular tax rise – to boost health spending. Recent polling shows more than half of the public would be prepared to pay more tax if it were earmarked for the NHS. Mrs May should take a leaf out of her predecessor’s book.
The Guardian view on the NHS: more cash, less dog-whistling needed | Editorial
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