The NHS crisis that none of the parties will discuss: how to pay for it

With a £30bn funding gap, all parties need to decide whether they would raise taxes, cut spending elsewhere, or impose patient charges. But don't expect them to tell us.

If there's one NHS issue that none of the parties are prepared to confront, it's that of funding. The common view is that the health service has been shielded from austerity by having its budget ring-fenced, but in reality the reverse is the case. Owing to the above-average rate of inflation in the service, the NHS requires real-terms rises just to stand still. As a recent Social Market Foundation paper noted, "A ‘flat real’ settlement for the NHS is mot what it sounds like since it is defined with reference to an irrelevant price index. To keep up with rising input costs, growing demand, and the public’s expectations for an adequate healthcare system, growth in spending on health has historically outstripped GDP growth." 

By historic standards, the NHS is undergoing austerity. Since 1950, health spending has grown at an average annual rate of 4%, but over the current Spending Review it will rise by an average of just 0.5%. As a result, in the words of the SMF, there has been "an effective cut of £16bn from the health budget in terms of what patients expect the NHS to deliver". Should the NHS receive flat real settlements for the three years from 2015-16 (as seems probable), this cut will increase to £34bn or 23%.

If they wish to avoid a significant fall in the quality and quantity of services, this government and future ones are left with three choices: to raise taxes, to cut spending elsewhere, or to impose patient charges. The third of these is proposed by the think-tank Reform today, which calls for a £10 charge for GP consultations, £10 fines for missed appointments, the introduction of a means-tested system for end of life care and an increase in prescription charges from £7.85 to £10 (with exemptions for those on low-incomes). It estimates that these measures would raise around £3bn a year, with research director Thomas Cawston commenting: "Few will want to debate higher NHS charges but the funding outlook for the service makes it unavoidable. Prescription charges are the easiest route to new revenue, with exemptions for people on low incomes built in." If this seems heretical, it's worth remembering that our "free" health service hasn't been truly free since Labour chancellor Hugh Gaitskell introduced prescription charges for glasses and dentures in his 1951 Budget (although they have now been abolished in Scotland, Wales and Northern Ireland).

But perhaps unsurprisingly, the Department of Health has responded by dismissing the idea out of hand. A spokesman said: "We have been absolutely clear that the NHS should be free at the point of use, with access based on need. That is why we have increased health spending in real terms alongside £20bn of efficiency savings to make sure the NHS continues to provide excellent care."

Labour, meanwhile, spying an opportunity to cause political mischief, has commented: "Patients will be alarmed that friends of Number 10 want to see charges for GP appointments and hospital care.

"Labour froze prescription charges before the election, but they have increased year on year under David Cameron. They are now creeping towards £10, as these plans want, and are adding to the cost of living crisis.

"The Government must come clean on any plans to charge for NHS care. They have already lost people’s trust over the crisis in A&E and thousands of axed nursing jobs – this will only add to it."

But this merely defers the question of how we will ultimately pay for a health service of the standard the public both expect and deserve. Will any party grasp this nettle before 2015? Don't count on it. 

Jeremy Hunt delivers a speech during his visit with David Cameron to the Evelina London Children's Hospital on July 5, 2013 in London. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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Is the French Left having its Jeremy Corbyn moment?

Benoit Hamon won the first round of the Socialist party's presidential primaries. 

Has the French Left taken a Corbynite turn? That's certainly the verdict of many after the first round of the French Socialist Party's primary.

In first place is Benoit Hamon, who quit Francois Hollande's government over its right turn in 2014, and counts the adoption of a universal basic income, the legalisation of cannabis and the right to die among his policy proposals, with 36 per cent of the vote.

In second place and facing an uphill battle to secure the nomination is Manuel Valls, the minister who more than any other symbolized the rightward lurch of Hollande's presidency, with 31 per cent. That of the five eliminated candidates - under the French system, if no candidate secures more than half of the vote, the top two go through to a run-off round - only one could even arguably be said to be closer to Valls than Hamon shows the struggle he will have to close the gap next weekend. And for a variety of reasons, even supporters of his close ally Sylvia Pinel may struggle to put a tick in his box. 

Still, Valls clearly believes that electability is his best card, and he's compared Hamon to Corbyn, who "chose to remain in opposition". Also making the Hamon-Corbyn comparison is most of the British press and several high-profile activists in the French Republican Party.

Is it merited? The differences are probably more important than the similarities: not least that Hamon served as a minister until 2014, and came up through the backrooms. In terms of the centre of gravity and the traditions of his party, he is much closer in analogue to Yvette Cooper and Andy Burnham than he is to Jeremy Corbyn, though Corbynistas and Hamonites bear a closer resemblance to one another than their leaders to.

What will give heart to the leader's office is that Hamon surged in the polls after each debate, when his ideas were given a bigger platform. But what will alarm everyone in Labour is the French Socialists' poll ratings - they are expected to get just 6 per cent in the elections. (And before you scoff at the polls, it's worth noting that they have, so far, performed admirably in the French electoral cycle, picking up on the lightning rise of both Hamon and Francois Fillon.)

That attests to something it's easy to forget in Westminster, where we tend to obsess over the United States and ignore politics on the Continent, despite the greater commonalities: throughout Europe, social democratic parties are in a fight for their lives, no matter if they turn to the left or the right.

The Democrats, in contrast, won the presidential election by close to three million votes and lost due to the electoral college. They have good prospects in the midterm elections and their greatest threat is gerrymandering and electoral malfeasance. But absent foul play, you'd have to be very, very brave to bet on them going extinct.

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.