Hopefully, we are now coming to the end of one of the hardest winters on record for the four NHS systems across the UK, as the severe weather and flu outbreak saw a surge in trauma and respiratory cases.
It has been particularly difficult for NHS England, where the images of patients stuck in ambulances outside hospitals, or waiting for hours in corridors before even entering Accident and Emergency Departments, have been truly shocking.
NHS England, where the images of patients stuck in ambulances outside hospitals, or waiting for hours in corridors before even entering Accident and Emergency Departments, have been truly shocking.
The four separate National Health Services, in each nation of the UK, have diverged significantly since devolution in 1999 but all face three key challenges – the increased demand associated with an ageing population, workforce shortages, which will be aggravated by Brexit, and tight budgets since the financial crash.
The first issue requires a step change in public health and a ‘health in all policies’ approach to everything from housing to active travel to allow us, not just to live longer – definitely to be celebrated – but to age well.
The workforce challenge will also take years to solve as the profession adjusts to the higher proportion of doctors choosing to work part time. This may improve work/life balance and reduce burnout but requires that we train considerably more doctors, which is an expensive business.
Then there is the money! Over the last 70 years, the NHS received an average uplift of 3.7 per cent each year in its funding but, since 2010, the increase has only been approximately one per cent each year. With increasing demand, this has put enormous strain on services, culminating in NHS England facing a £2.45 billion deficit in 2016. This has been further aggravated by the estimated £5 billion cost of just administering the healthcare ‘market’ created within NHS England – something we have been spared in NHS Scotland.
If a Parliamentary Commission was set up, it could consider whether outsourcing – the Health and Social Care Act forced healthcare contracts to be put out to tender between NHS England and private companies – is cost effective or is undermining cooperation and integration. Overall funding for NHS England, and the impact of outsourcing to private companies, are the commonest causes of bitter debate and argument at Westminster and, due to the Barnett formula, directly affect the funding available to the devolved Governments.
The idea of a Parliamentary Commission – called for in a letter to Theresa May signed by dozens of MPs from different parties – is to establish a cross-party committee which can step back from the confrontation of Parliament and look at the whole principle of sustainable funding for healthcare so that it is not an annual fight in the House of Commons.
This Commission would include members from outside Parliament and hear expert evidence on many options, from a hypothecated tax to fund the NHS to changes in National Insurance, and then attempt to consider the fairest and most sustainable solutions that maintain the principles of the NHS.
For those involved who represent the devolved nations, it will also be important that prospective solutions for NHS England do not negatively impact on the funding available for the health services of Scotland, Wales or Northern Ireland. While it is not at all clear that the UK Government will agree to such a Commission, it could allow less politically heated debate around the issue of healthcare funding and, therefore, perhaps shed a little more light.