By Anita Charlesworth
Even before Boris Johnson's intervention on Tuesday, the political spotlight has been firmly on the NHS this month. Any doctor or nurse will tell you that the current pressures on A&E departments are the canary in the mine; the struggle to manage a difficult winter symptomatic of much deeper problems. Fundamentally, the chickens of seven years of austerity are firmly home to roost.
The size of the NHS – almost £1 in every £5 of public spending, employing over a million people – makes problems in the health service hard to manage even for governments with a healthy majority. But what makes the health service so politically difficult is its salience with the public. The New York Times recently asked on Twitter:
"Have you, or any of your family members, been a patient with the N.H.S.? We'd like to hear about your experience."
The flood of replies pointed out that the challenge in the UK is not to find someone who has had experience of the NHS but rather to find someone who hasn't. A lovely culture clash moment.
The Brexit campaign majored on the NHS because it matters so much to so many people regardless of traditional political divides. Opinion polling finds that the NHS is consistently in the top three issues of concern for the public. Support remains rock solid with almost nine in 10 in favour of a tax funded, comprehensive service free at the point of use. That support crosses all age groups, regions, income brackets and political affiliations. And the government is losing the perceptions battle on its stewardship of the service. Labour has a growing 19 point lead on public trust to look after the health service.
The politics clearly points to the need to do something big and bold. At Tuesday's cabinet meeting Boris Johnson resurrected his Brexit call for more NHS funding and a need for a better political grip on the issue. Philip Hammond and Theresa May are no doubt frustrated at this intervention coming just two months after the Autumn Budget injected an extra £2bn a year to the NHS, as well as almost £350m of short-term cash. While the NHS is clearly a priority for any extra cash, Hammond is boxed in by the overall economic outlook - the IMF's latest forecast shows the UK's economy growing by just 1.5% over the next two years, well below the global economy's growth of almost 4%.
The problem is, these one-off cash injections don't tackle the root causes of the problem. The extra money in November's Budget was about half what was needed for next year. The money that Johnson has called for would amount to an additional £5.2bn a year – enough to meet demands for the next year or so, but with a funding gap of about £20bn a year by 2022/23 this is still just kicking the can a little further down the road.
Ninety MPs, including 33 Conservatives, have written to the prime minister and argued powerfully for a change of tack. There is a growing consensus from politicians, Royal Colleges, NHS leaders and health think tanks that short-termism, coupled with boom and bust funding has plagued our approach to the NHS for decades. It is bad for staff and patients, and is of questionable benefit to the taxpayer as it almost certainly erodes efficiency.
Boris Johnson's call for more funding generated many headlines, as have separate calls for a Royal Commission on the NHS. But something less headline-grabbing needs to be at the heart of the political response to the current problems. The House of Lords' recent report on the sustainability of the NHS argued for a new body modelled in large part on the success of the Office for Budgetary Responsibility (OBR). The OBR doesn't set economic policy but has improved transparency and accountability for tax and spending decisions on an ongoing basis. However the current crisis evolves, an OBR for health would be a real, tangible improvement to health service policy making and in this 70th anniversary year of the NHS, a sign of our commitment to its long-term future.
Anita Charlesworth is the director of research and economics at the Health Foundation
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