No political party is taking the NHS seriously in this election
Edmund Stubbs, 1 May 2015
NHS England’s ‘Five Year Forward View’, along with the statements of most other key health stakeholders, including the Institute of Fiscal Studies, the King’s Fund and The Nuffield Trust, agree that a projected a £30 billion annual funding gap for the NHS will exist by the end of the next parliament. There seems little doubt that the amount of this enormous deficit is correct.
Worryingly, The NHS’s chief executive Simon Stevens, along with the rest of NHS England have been too optimistic in claiming that £22 billion of efficiency gains to offset this deficit can be made. The Five Year Forward View states that if the NHS continues to make its current efficiency gains of 0.8% per year there will still remain a £21 billion funding gap. However, even these efficiency gains have been hard to achieve over the term of this parliament. Implementing them has meant that reimbursement for treatment has been cut, wages have been frozen and, as a result, service quality has suffered. It is difficult to envisage how such drastic efficiency savings can continue to be demanded of the NHS in years to come.
The Five Year Forward View further states that if the NHS almost doubles its current efficiency savings to a rate of 1.5% per year, then the projected funding gap would be halved to one of £16 billion. With NHS services already struggling to cope under current efficiency drives, and staff and patients bearing the hardship such savings bring, it is hard to imagine a doubling of effort. These higher efficiency gains could only actually be realised by cuts to services. Consequently they are unlikely to be achieved with present political sensibilities.
The major parties’ election manifestos are constructed around NHS England’s implied projection that it can make £22 billion worth of savings, only therefore requiring £8 billion a year from the next government by the end of the next parliament to make up the funding shortfall.
Interestingly, this specific figure of £22 billion is not to be found in the Five Year Forward View itself, Simon Stevens and his team requested the £8 billion in relation to their claim that cumulative 3% annual efficiency gains could be made over the term of the next parliament and would thus save the NHS £22 billion a year. This was their most optimistic scenario which in the actual report they projected in relation to a vague 2-3% annual efficiency saving after the cost of ‘the needed infrastructure and operating investment’.
If achieving efficiency gains of 1.5% per year seems optimistic , gains of 3% seem almost impossible! This is the opinion of many health experts, including, the past chief executive of NHS England, Sir David Nicholson.
Politicians have essentially ‘ducked’ the realities of NHS funding in their health policy pronouncements in the course of this election campaign. Promises such as ‘extra nurses and doctors’ or ‘7 day GP services’ are simply not based on any realistic appraisal of the NHS’s funding situation. No presently promised budget increase will be enough, any extra money allocated will simply keep the NHS ‘afloat’ a little longer before it inevitably sinks. Its capacity to actually treat patients will not be improved. There is little point in pumping cash into expensive, acute emergency rescue services if we are not trying to stop the causes of illness in the first place!
It is safe to say that once elected, any new government’s promises made before the election will in no way resemble what will actually be implemented afterwards. One thing alone is certain, none of the parties are taking the NHS seriously.
Edmund Stubbs, Healthcare Researcher, @edmundstubbs1