We need a cross-party commission on the NHS

There have been no Tory health cuts, but the system will never be sustainable without structural reform

Dogs bark, cows moo, and Labour puts up taxes. It also batters the Conservatives on the NHS. From Aneurin Bevan to Jeremy Corbyn, Labour has claimed the Tories want to privatise the National Health Service and cut its funding. In truth, the fastest expansion of the use of the private sector in the NHS came under Tony Blair. And the only NHS budget cuts in history were initiated by Labour following economic crises during the Fifties and Seventies.

Under David Cameron and Theresa May, health spending has gone up every year, and the Government plans to increase it, per capita and in real terms, every year until the next election.

There are, then, no Tory health cuts. Yet this week thousands of operations were postponed until February. GPS are being drafted into A&E departments, and patients will stay in mixed-sex wards. What is going on?

The honest truth is that health spending is not rising fast enough to allow the service to cope with increasing demand. According to the Institute for Fiscal Studies, between 2009-10 and 2019-20, health spending will have risen by 12 per cent, or 1.1 per cent per year. This is stronger than population growth, which means that per capita spending will increase by 3.5 per cent over the decade. After adjusting the figures to account for our ageing population, however, the IFS found that, in effect, per capita spending will have fallen by 1.3 per cent over the 10 years.

The problem is not just about money. As the Care Quality Commission (CQC) reports, “There are substantial variations in the quality of care… within and between services in the same sector, between different sectors, and geographically.” If health and care services could be better joined up, and if all parts of the NHS could learn from the best performers, there would be significant improvements in productivity and service. In particular, poor social care provision is causing huge problems for the NHS. In October, hospitals lost more than 170,000 bed days as a result of delays in discharging patients who were fit to leave, and 60,000 – more than a third – were caused by problems with social care provision.

Some argue that this proves that the NHS is unsustainable, and we need a social insurance system instead. That would be one way of increasing health spending overall, but the inevitable inequality that it would involve would be contrary to the founding principle of the NHS and unpalatable to the public. Neither would it be a panacea for our funding problems: insurancebased health systems face rising costs too, and several studies conclude that the NHS is more efficient than most of its international counterparts.

So, what can be done? NHS productivity is improving by 1.7 per cent a year, which is faster than its historical performance and better than the wider economy. However, sensible, managerial reform must continue. Workforce planning must be modernised. The best NHS leaders should run more hospitals. And capital investment can be increased by releasing valuable health service property assets.

Unnecessary bureaucracy can be removed by reversing the crazier aspects of the NHS internal market. What began as a sensible reform to establish price transparency, improve accountability and increase patient choice – where choice is practical in healthcare – has become a Byzantine bureaucracy.

As the CQC says, more should be done to integrate health and social care provision. With new funding made available by Mrs May, and the increase in what local authorities are allowed to raise for social care through council tax, the post-2010 social care cuts will be reversed by the end of the decade. However, with an ageing population, this is unlikely to be enough: a lasting solution is needed. In the meantime, ministers could lift the cap on the social care element of council tax bills altogether.

The health service itself will need extra funds. The King’s Fund estimates that, in the next financial year, the NHS will get £4billion less than it needs. Ministers could increase the health surcharge for foreign workers and overseas students and, following Britain’s departure from the EU, they could spend at least some of the Brexit dividend on the NHS.

In the meantime, another option might be to increase employees’ National Insurance Contributions. To ensure the younger generation does not pay, yet again, for our ageing society, the increase could be limited to workers above the age of 40.

Ultimately, however, we need a sustainable solution to the finances and structure of the NHS and social care system. Andrew Lansley’s reforms have proved a disaster, creating bureaucracy and destroying accountability. The Government has little political space to undertake radical changes, but Mrs May and Jeremy Hunt can use the coming years profitably: they can launch a crossparty Royal Commission into the future of health and social care.

Mr Corbyn may spurn them, but Labour moderates will not: it is time to make the move.