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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Commons confidential: Vive May's revolution

It's a risky time to be an old Etonian in the Tory party. . . 

The blond insulter-in-chief, Boris Johnson, survives as Theresa May’s pet Old Etonian but the purge of the Notting Hell set has left Tory sons of privilege suddenly hiding their poshness. The trustafundian Zac Goldsmith was expelled from Eton at the age of 16 after marijuana was found in his room, unlike David Cameron, who survived a cannabis bust at the school. The disgrace left Richmond MP Goldsmith shunned by his alma mater. My snout whispered that he is telling colleagues that Eton is now asking if he would like to be listed as a distinguished old boy. With the Tory party under new, middle-class management, he informed MPs that it was wise to decline.

Smart operator, David Davis. The broken-nosed Action Man is a keen student of geopolitics. While the unlikely Foreign Secretary Johnson is on his world apology tour, the Brexit Secretary has based himself in 9 Downing Street, where the whips used to congregate until Tony Blair annexed the space. The proximity to power gives Davis the ear of May, and the SAS reservist stresses menacingly to visitors that he won’t accept Johnson’s Foreign Office tanks on his Brexit lawn. King Charles Street never felt so far from Downing Street.

No prisoners are taken by either side in Labour’s civil war. The Tories are equally vicious, if sneakier, preferring to attack each other in private rather than in public. No reshuffle appointment caused greater upset than that of the Humberside grumbler Andrew Percy as Northern Powerhouse minister. He was a teacher, and the seething overlooked disdainfully refer to his role as the Northern Schoolhouse job.

Philip Hammond has the air of an undertaker and an unenviable reputation as the dullest of Tory speakers. During a life-sapping address for a fundraiser at Rutland Golf Club, the rebellious Leicestershire lip Andrew Bridgen was overheard saying in sotto voce: “His speech is drier than the bloody chicken.” The mad axeman Hammond’s economics are also frighteningly dry.

The Corbynista revolution has reached communist China, where an informant reports that the Hong Kong branch of the Labour Party is now in the hands of Britain’s red leader. Of all the groups backing Jezza, Bankers 4 Corbyn is surely the most incongruous.

Labour’s newest MP, Rosena Allin-Khan of Tooting, arrived in a Westminster at its back-stabbing height. Leaving a particularly poisonous gathering of the parliamentary party, the concerned deputy leader, Tom Watson, inquired paternalistically if she was OK. “I’m loving it,” the doctor shot back with a smile. Years of rowdy Friday nights in A&E are obviously good training for politics.

Kevin Maguire is the associate editor (politics) of the Daily Mirror

Kevin Maguire is Associate Editor (Politics) on the Daily Mirror and author of our Commons Confidential column on the high politics and low life in Westminster. An award-winning journalist, he is in frequent demand on television and radio and co-authored a book on great parliamentary scandals. He was formerly Chief Reporter on the Guardian and Labour Correspondent on the Daily Telegraph.

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue