The health service can no longer provide everything for everyone
The National Health Service challenge facing the Prime Minister is not an easy one. From a weak political position, Theresa May must work out how to help the NHS and see it through its immediate difficulties without entering a Dutch auction of promises to increase funding – an auction no Conservative government can ever win against Labour. Yet if she does not act, things could turn very ugly indeed, with doctors blaming her Government for the deaths of patients.
Something hugely damaging, akin to the political aftermath of the Grenfell fire, could befall the PM and Jeremy Hunt, her Health Secretary.
Mrs May cannot allow this to happen; so what can be done to alleviate the immediate pressure? Philip Hammond, the Chancellor, provided an additional £350million in the Budget for winter pressures, so there is money available. As always in the NHS, questions exist as to whether it is reaching the frontline and is being used there efficiently. Despite the questions, there are only two shortterm fixes: even more money and accessing local community resources in the form of volunteers.
The PM will need to accept that more money, possibly several hundreds of millions, will have to be injected immediately to try to control the pressure points. Some of it will be spent inefficiently in hospitals on things such as agency staff. But it is also desperately needed to pay for extra help within local authorities, to provide support for elderly people who are leaving hospital to free up much-needed beds.
Mr Hunt should also mobilise an army of trained and committed volunteers, many of whom are EX-NHS employees, to take the pressure off doctors and nurses. Hospitals may need temporary help with costs, such as expenses for these volunteers and their co-ordinators, which the Government should provide.
A voluntary sector summit at No 10 on Monday morning to activate its
‘Too many families and communities have passed their responsibility for caring to the State’
help should be a priority. None of this is ideal but the bullet has to be bitten.
In the longer term, bigger changes are required – this crisis is not simply about money. First, the NHS needs to define clearly what it is there for and the limits to its service. It cannot continue, endlessly, to provide everything to everybody and for free. Second, important community and societal change is required. After 70 years of the NHS, too many families and communities have passed their responsibility for caring to the State. The result is extreme isolation, loneliness and increased susceptibility to poor health, meaning more visits to GPS and hospitals.
The Government must nudge families and communities into taking more responsibility for the well-being of elderly people. But it must also invest in charities, social enterprises and voluntary groups to provide local support for families. Mrs May needs to breathe life into her “Shared Society” concept or re-energise her predecessor’s “Big Society”. A new deal and long-term partnership with the third sector is essential.
Third, additional finance is needed, but the idea of a hypothecated NHS tax is too simplistic. It could enshrine inter-generational unfairness as younger people struggle to afford the increased burden. It could also provide the NHS with a blank cheque where inefficiency thrives. There would also be relentless pressure for a health tax to rise – and very steeply indeed under Labour. The scope of what the NHS does would widen exponentially. My preference would be for an all-party commission to agree a 10-year funding settlement that includes agreed reforms and stringent efficiency targets.
Whatever the Government does next, it must find answers for the NHS and social care conundrum. Otherwise Labour will continually outbid the Conservatives with promises of stacks of extra cash – then attempt to destroy them with endless stories of horror and even patient deaths.