The National Health Service is drifting towards its 70th birthday in an enfeebled state. Hospital trusts are unable to meet their spending obligations: a deficit of £960m was recorded for 2017/18 – nearly twice the expected figure of £496m. There are now 93,000 NHS posts unfilled – 1,518 visa applications by foreign doctors were rejected in the four months to March.
There is no mystery about the source of these maladies. In the latter case, the government’s arbitrary net migration target of “tens of thousands” a year (which Theresa May has long championed) severely restricts non-EU immigration. Though the target has never been met in the 97 months since it was proclaimed, it has imposed severe costs.
A dearth of workers has been accompanied by a dearth of funding. Though the Conservatives like to boast that NHS spending has been “protected” since 2010, the health service has in fact endured the longest period of austerity in its history.
Since 1950, health expenditure has grown at an average annual rate of 4 per cent; over the last parliament it rose by an average of just 0.5 per cent. An ageing population, the rising cost of drugs and technology and the growth of chronic conditions, such as obesity and diabetes, all mean that the NHS depends on above-inflation increases. The £4.5bn cut to social care funding has only intensified the pressure on the service (forcing the NHS to act as a provider of last resort).
Before last November’s Budget, health leaders warned that this fiscal famine could not endure. Simon Stevens, the NHS chief executive, requested a minimum increase of £4bn in 2018 (far below the £18.2bn – or £350m a week – promised by the Leave campaign). “2018, which happens to be the 70th anniversary of the NHS, is poised to be the toughest financial year,” he warned.
After nearly a decade of austerity, Stevens noted, Britain was underfunding the health service by £20-30bn compared to comparable countries such as Germany, France and Sweden. But Philip Hammond offered just £1.6bn for this year – less than half the amount Stevens demanded. Patients have borne the cost in delayed operations, cancelled appointments and bed reductions.
Mindful of the NHS’s landmark birthday, Theresa May intends to announce a spending increase of three per cent a year, a sum that by the time of the next election would amount to an extra £350m a week.
This, however, is still short of the average historic increase of 4 per cent a year – the amount experts believe the NHS requires merely to stand still.
In 2002, Gordon Brown rose National Insurance by 1p to pay for the largest-ever increase in NHS funding (£40bn). In the years that followed, patient satisfaction reached record levels. Nearly two decades later, as the service daily declines, the need for a new financial settlement has never been greater.
Whatever the Prime Minister eventually announces will be inadequate compensation for the avoidable misery of the last eight years.