As budget freezes and reforms set in, what next for the NHS? - UK Politics - UK - The Independent

As budget freezes and reforms set in, what next for the NHS?

In the light of the damning King’s Fund’s report, Charlie Cooper examines some of  the health service’s unpalatable options

Health Reporter

Option 1: Keep the budget steady

Since coming to power, the Coalition has ring-fenced the health budget, protecting the NHS from the kind of swingeing cuts that other departments have suffered. However, the rate at which the budget has increased has slowed down to almost zero. With ever-increasing demand for care and rising health-care costs, this means the NHS has – effectively – been cut.

Carrying on along this path after the 2015 election would, according to the King’s Fund, mean accepting “significant cuts” to services.

Richard Murray, the think-tank’s director of policy, said it was hard to speculate which services might be under threat, but on past form, public health (such as smoking, alcohol and obesity campaigns) might be the first to face cuts, along with training for doctors and nurses.

“If there’s going to be a decision to cut, it’s going to have to be a very explicit one by any new government,” he told The Independent. “You might lose temporary staff, you cut back on the things that physically you can cut back on.”

Currently the NHS budget is due to increase by just 0.1 per cent in 2014/15. The Coalition has limited itself to similarly small increases since it came to power. According to Mr Murray, this amounts to a sustained financial squeeze on a scale “unheard of” in the history of the NHS.

“There’s a difference between not cutting the NHS and giving it the growth that it may need,” he said. “Holding down the budget so that it doesn’t grow at all is pretty exceptional. Even though it may look good compared to [the cuts] to local government, by health standards it’s pretty remarkable.”

Option 2: Increase spending

The obvious answer to the NHS’s financial crisis, and the one that has been turned to repeatedly in the history of the health service, would be to increase spending again.

While the NHS represents a sizeable portion of the UK Government’s total public spending, it is in fact relatively inexpensive by international standards. France and Germany, countries of comparable economic development to the UK, both spend more as a proportion of GDP on health than the UK. The US spends considerably more, albeit in a different health economy ruled by the whims of the market.

Advocates of increased spending cite the international comparisons to point out that there is still plenty of scope for the NHS budget to increase, arguing that the decision not to do so is a political, not an economic one.

Dr Clive Peedell, leader of the National Health Action Party, which will field candidates in the European elections and the general election on a platform of opposing health service cuts and resisting any attempts to expand the role of the private sector, said that the consequences of keeping the budget frozen would be “hospital closures, service cuts and mass staff redundancies”.

“Next winter could be the tipping point for the NHS and for the electoral prospects of the Conservatives and Liberal Democrats,” he said. “They have made the catastrophic mistake of pushing forward an NHS austerity agenda, whilst simultaneously attempting to deliver the biggest top-down reorganisation of the NHS in its history.”

Labour, historically seen as more sympathetic to increased health spending, are yet to make any firm electoral commitments on NHS funding, but have pledged to revoke many of the Coalition Government’s health reforms.

Option 3: Find new sources of funding

The unthinkable option for most politicians, at least in terms of their public pronouncements, would be to find new revenue streams for the NHS.

One significant (but under-reported) clause in the Coalition’s health reforms lifted the ceiling on the amount of income an NHS hospital trust can make from fee-paying patients: from 2 per cent to 49 per cent.

Think-tanks including Reform, which has close links to advisors of both the Health Secretary Jeremy Hunt and David Cameron, have discussed introducing fees for certain services, such as seeing your GP, as a possible means of making the NHS more affordable in the long-run, without forcing the Treasury to open the purse strings.

Another tool in the Government’s inventory would be to expand the role of the private sector. Health officials are understood to admire the work that Circle Healthcare have done at Hinchingbrooke, the first NHS hospital to be run by a private provider.

For cash-strapped healthcare commissioners, private providers who offer to run NHS services at a competitive price may become an increasingly attractive option.

However, fees and privatisation are still, according to Mr Murray, “political anathema”, and it would be a bold move on the part of the Conservative Party – or the Liberal Democrats – to publicly promote them as a key strategy ahead of the next election.

Mr Murray said that the political parties would need to be cautious of anything that challenged widespread public “loyalty” to the NHS.

“I don’t think the public yet are aware that trouble looks increasingly likely,” he said. “As it comes closer and more people open up newspapers to find another hospital going cap in hand to the Department of Health to say they can’t pay the bills, it’s a question the political parties will have to put to the public – what do you want to do about this? Loyalty ratings in the NHS are still very high. These are questions that will play out over the next year.”

News
Paper trail: the wedding photograph found in the rubble after 9/11 – it took Elizabeth Keefe 13 years to find the people in it
newsWho are the people in this photo? It took Elizabeth Stringer Keefe 13 years to find out
Arts and Entertainment
Evil eye: Douglas Adams in 'mad genius' pose
booksNew biography sheds light on comic genius of Douglas Adams
Sport
FootballFull debuts don't come much more stylish than those on show here
News
i100
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
Life and Style
Kim Kardashian drawn backlash over her sexy swimsuit selfie, called 'disgusting' and 'nasty'
fashionCritics say magazine only pays attention to fashion trends among rich, white women
Arts and Entertainment
TVShows like Agents of S.H.I.E.L.D are little more than marketing tools
Arts and Entertainment
Hit the roof: hot-tub cinema east London
architectureFrom pools to football pitches, rooftop living is looking up
Travel
travel
News
The ecological reconstruction of Ikrandraco avatar is shown in this illustration courtesy of Chuang Zhao. Scientists on September 11, 2014 announced the discovery of fossils in China of a type of flying reptile called a pterosaur that lived 120 millions years ago and so closely resembled those creatures from the 2009 film, Avatar that they named it after them.
SCIENCE
Life and Style
tech
Arts and Entertainment
Matisse: The Cut-Outs exhibition attracted 562,000 visitors to the Tate Modern from April to September
art
Life and Style
Models walk the runway at the Tom Ford show during London Fashion Week Spring Summer 2015
fashionLondon Fashion Week 2014
News
Kenny G
news
News
peopleThe black actress has claimed police mistook her for a prostitute when she kissed her white husband
Life and Style
techIndian model comes with cricket scores baked in
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Energy Markets Analyst

£400000 Per Annum: The Green Recruitment Company: Job Title: Energy Markets An...

Junior Web Analyst – West Sussex – Up to £35k DOE

£30000 - £35000 Per Annum Plus excellent benefits: Clearwater People Solutions...

Nursery Manager

£22000 - £23000 per annum: Randstad Education Bristol: We are currently recrui...

Web Analyst – Permanent – Up to £40k - London

£35000 - £40000 Per Annum: Clearwater People Solutions Ltd: We are currently r...

Day In a Page

Mystery of the Ground Zero wedding photo

A shot in the dark

Mystery of the wedding photo from Ground Zero
His life, the universe and everything

His life, the universe and everything

New biography sheds light on comic genius of Douglas Adams
Save us from small screen superheroes

Save us from small screen superheroes

Shows like Agents of S.H.I.E.L.D are little more than marketing tools
Reach for the skies

Reach for the skies

From pools to football pitches, rooftop living is looking up
These are the 12 best hotel spas in the UK

12 best hotel spas in the UK

Some hotels go all out on facilities; others stand out for the sheer quality of treatments
These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

Widespread fear of Isis is producing strange bedfellows

Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
Topshop goes part Athena poster, part last spring Prada

Topshop goes part Athena poster, part last spring Prada

Shoppers don't come to Topshop for the unique
How to make a Lego masterpiece

How to make a Lego masterpiece

Toy breaks out of the nursery and heads for the gallery
Meet the ‘Endies’ – city dwellers who are too poor to have fun

Meet the ‘Endies’ – city dwellers who are too poor to have fun

Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

Ian Paisley’s decision to make peace with his IRA enemies

His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

Exclusive extract from Janis Winehouse's poignant new memoir
Is this the role to win Cumberbatch an Oscar?

Is this the role to win Cumberbatch an Oscar?

The Imitation Game, film review
England and Roy Hodgson take a joint step towards redemption in Basel

England and Hodgson take a joint step towards redemption

Welbeck double puts England on the road to Euro 2016
Relatives fight over Vivian Maier’s rare photos

Relatives fight over Vivian Maier’s rare photos

Pictures removed from public view as courts decide ownership
‘Fashion has to be fun. It’s a big business, not a cure for cancer’

‘Fashion has to be fun. It’s a big business, not a cure for cancer’

Donatella Versace at New York Fashion Week