No domestic political issue carries the urgency and importance of the funding of the NHS.
As The Independent has been reporting this week, the increasing demands placed on the service threaten its very future – at least in anything like the form that Britain has come to know it since it was created in the aftermath of the Second World War.
The NHS has been through seismic funding change before – in the 1980s when Margaret Thatcher’s internal market reforms created the landscape of commissioners and trusts we know today; and in the 1990s when Tony Blair responded to lengthening waiting times with the biggest injection of spending the health service has ever seen.
Such moments are inevitable, and now, after an era of unprecedented austerity, here we are again. The NHS is facing a £30bn deficit within five years, and it will take a lot of political will to fill it. Each NHS funding scare demands that the public and politicians of the day take stock and answer a simple question: are we still prepared to pay for the NHS? Or, to put it another way, do we still believe that care should be given according to need, not ability to pay? Are we, as a society, prepared to share in one another’s risk? The consensus among the clinicians, politicians, economists and members of the public we have reported on this week is yes we do, and yes we are.
That is a hugely welcome sign, but if we want a health service built on that principle, then wiping out its deficit will not be enough. As the number of elderly people grows, it becomes more intolerable that they must pay for much of their own care. A lifetime’s savings can be lost paying for basic dignity at the end of life. Cuts to council-funded social care have left thousands without any help whatsoever – because they can’t afford it. If the NHS principle is about anything, it is about ending injustices like this.
An ever-louder chorus of voices is calling for social care to be part of the NHS and become free at the point of use. In the long run, guaranteeing free care in the home and the community for hundreds of thousands of frail elderly would make the NHS more efficient and more effective. Far fewer of these people would end up receiving expensive hospital care simply because, as is the case now, there is nowhere else to go.
But these changes are going to cost money – between £3bn and £5bn extra a year, on top of the £113bn (and rising) cost of the NHS – and no political party’s solution to the problem is satisfactory. The Conservatives’ pledge to “protect” the budget sounds suspiciously like more of the same. Keeping the budget flat will mean that waiting times continue to rise, and longer queues at A&E and the GP surgery. The Liberal Democrats’ £1bn per year investment is worthy, and well thought out, but not nearly enough, while Labour’s plan for £2.5bn extra funding each year, paid for by a mansion tax and a crackdown on tax avoidance, would not come into effect until a year into the next parliament. Even then, it would not be enough to deliver a true National Health and Care Service – as proposed by the shadow Health Secretary.
So far, the most coherent plans have come from Labour MP Frank Field, who has said the things party leaders dare not – that the public should pay more, through higher national insurance contributions. Polls say that the public would be willing. David Cameron, Ed Miliband and Nick Clegg have made their promises to our NHS but the public is unconvinced. Before May 2015, we’ll need to hear a better offer.