That £350m “commitment” could be damaging
The debate in Britain about health spending is fundamentally dishonest. The left constantly press for large increases in spending. The government constantly boasts about ever-increasing spending at or above inflation levels. Voices on the right frequently argue for scaling back the health services that the public sector provides. None of them address what Britain needs.
Britain’s health needs are growing at a rate far faster than inflation, even if one uses measures of healthcare inflation. Those needs are not growing in line with prices but demography. 40% of NHS spending is devoted to those aged 65 and over, though that group comprises only 18% of the population, with this spending concentrated in the older age bands. 70% of NHS spending in England is directed towards just 25% of the population – those with incurable long term conditions. As the nation’s population inexorably gets older and as those with incurable long term conditions can be supported more effectively, costs will inevitably rise.
Make no mistake, it is good news that we are living longer and that those with health needs can be supported more effectively. But that good news comes with a cost and one that rises as we age. By 2039 the Office for National Statistics estimates that those aged 75 or over will increase from 8% of the population to over 13% of the population. (Besides being the most needy of resources, the over-75s are also the most violent.) Healthcare costs, if no changes are made to NHS coverage, will rise far in excess of inflation for the next generation. Increasing funds for the NHS is like throwing cakes at a bear.
There is no easy solution. To make the books balance, either taxes will need to rise steeply, other government spending will need to be reduced significantly or NHS services will need to be cut sharply. Probably we will need to see a combination of all three. There is a crunch coming and it cannot be deferred indefinitely.
That crunch may be coming very soon indeed. 75% of acute hospitals are in deficit – only 8% of NHS providers were in deficit in 2009/10. The NHS has managed to keep the show on the road in the last few years by spending more than it receives. That is not a sustainable model in the long term and may not be sustainable in the short term. Ambulance response rates are worsening, waiting times after referral are deteriorating (cancer treatment waiting time targets have not been met since 2014) and A&E waiting time targets are now routinely being missed, with the latest quarter showing the most patients delayed in a decade. Pressures are building up in the system. The sense of crisis building is palpable.
The government will be hoping for another quiet winter in the health service, as are we all. Given the state of hospital finances and current performance, there is no particular reason to expect that hope to be met. The media reporting on a crisis in the NHS this winter looks considerably more likely than not.
The public aren’t expecting this at all. They’ve just voted in a referendum where they were told that £350 million a week could be saved for the NHS. Reasonably enough they are going to ask why this has not happened. They are unlikely to be impressed to be told that the money is not going to be available, that actually the £350 million was earmarked for other things as well, that Brexit has yet to happen, that the Leave camp are not the government and that it wouldn’t make all that much difference anyway. Pointing at the small print will just leave the public feeling duped and angry.
If the public think that they have been had, this is probably going to do nothing to assuage concerns about how Brexit is developing. Theresa May has pencilled in March for triggering Article 50 (subject to whatever the courts might rule about this). Nothing much looks likely to happen before then and the vacuum about what Brexit means seems likely to continue till then, with increasing alarm among the public about the absence of a disclosed plan. If Leave’s flagship policy comes to be seen as a con in the public’s eyes, public confidence in the whole idea is likely to dissipate at high speed.
So Leavers should be thinking right now what they’re going to be telling the public if the NHS does go through a rough patch this winter. The NHS’s problems could rapidly become their own.