Nine influential signatories to a letter published in the Times have asked for a national debate on how the NHS in England is funded. The authors of this letter assert that challenges from an ageing and growing population, plus new expensive treatments, mean the system is creaking at the seams and likely to need an extra £30bn by 2020.
The proposed national debate would be likely to consider options including higher taxes, payments for certain aspects of health care and / or a review to rationalise which treatments and services are available through the NHS (and to whom).
Leading health experts in NHS funding debate call. London: BBC Health News, July 7th 2014.
Possibly also of interest:
Pym, H. (2014). The key questions for the NHS. London: BBC Health News, July 7th 2014.
House of Commons Health Select Committee Report
This letter relates, in large measure, to a report from the House of Commons Health Committee inquiry into the care of people with long-term conditions (LTCs). Roughly 15 million patients currently account for 70% of annual NHS expenditure in England. It is estimated that treating LTCs could need NHS funding to increase by £4 billion every year by 2016.
House of Commons Health Committee. Managing the care of people with long-term conditions. Second Report of Session 2014–15. Volume 1: Report, together with formal minutes, oral and written evidence. Ordered by the House of Commons to be printed 18 June 2014. HC 401. London: The Stationery Office, July 3rd 2014.
House of Commons Health Committee. Managing the care of people with long–term conditions. Second Report of Session 2014–15. Volume 2: Additional written evidence. Ordered by the House of Commons to be printed 18 June 2014. HC 401. London: The Stationery Office, July 3rd 2014.
Nuffield Trust Inputs to the Debate
Nearly half of 78 health and care leaders surveyed by the Nuffield Trust believe the status quo is no longer an option:
Triggle, N. (2014). Fears raised ‘free NHS’ will come to an end. London: BBC Health News, July 10th 2014.
Also of interest:
Triggle, N. (2014). The NHS budget: Five things we’ve learned. London: BBC Health News, July 10th 2014.
This relates to:
Lafond, S. Arora, S. Charlesworth, A. [et al] (2014). Into the Red? The state of the NHS’ finances. An analysis of NHS expenditure between 2010 and 2014. London: Nuffield Trust, July 2014.
Political Posturing (2014)
Possibly of interest, Ed Miliband at the 2014 Labour Conference proposed recruiting 36,000 NHS doctors, nurses and other health staff.
Ed Miliband promises £2.5bn funding boost ‘to save NHS’. London: BBC Health News, September 23rd 2014.
Further BBC News commentary, with a historical perspective on NHS spending:
Triggle, N. (2014). Labour bares its teeth on the NHS. London: BBC Health News, September 24th 2014.
Subsequent Labour pledges on cancer test waiting times (by 2020) and a one-week target for all urgent diagnostics, not just cancer (by 2025):
Cancer test waiting times to be cut in England, Labour pledges. London: BBC Health News, October 18th 2014.
Labour has also promised to address the tide of “ever-increasing hospitalisation” of older people, by transforming hospital trusts and NHS bodies into integrated care organisations.
Burnham: NHS ‘not for sale’ in Labour hands. London: BBC Health / Politics News, September 24th 2014.
A letter signed by 140 doctors, published in the Guardian, asserted that the Coalition government has undermined and weakened the NHS in England:
Coalition ‘has undermined NHS’, doctors say in letter. London: BBC Health News, April 8th 2015.
Outsourcing: a Separate Debate
The Labour Shadow Health Secretary has asserted that NHS privatisation is underway, at scale and pace, under the guise of outsourcing designed to achieve best value and improved outcomes for patients.
Gallagher, J. (2014). Halt NHS privatisation, says Labour’s Burnham. London: BBC Health News, July 29th 2014.
One potential privatisation example cited is a £1.2bn contract plan for cancer care across Staffordshire, which may be the biggest outsourcing initiative in NHS history.
Staffordshire cancer care ‘could be privatised’. London: BBC News – Stoke and Staffordshire, July 3rd 2014.
Possibly also of interest:
Pym, H. (2014). The very public NHS privatisation debate. London: BBC Health News, July 31st 2014.
MPs back bill designed to limit NHS ‘privatisation’. London: BBC Health News, November 21st 2014.
A slightly less biased view? Lord Darzi believes it to be irrelevant whether NHS care is delivered by the private or public sectors.
Stratton, A. (2015). Lord Darzi: Labour wrong to rule out private NHS care. London: BBC Politics / Health News, January 29th 2015.
Further BBC News analysis:
Triggle, N. (2015). NHS privatisation: Why the fuss? London: BBC Health News, February 20th 2015.
A Freedom of Information (FOI) request made by the British Medical Journal (BMJ) has revealed that one-third of the 3,494 NHS contracts awarded by 182 Clinical Commissioning Groups in England have been awarded to private sector organisations, following the introduction of the Health and Social Care Act.
The Department of Health has responded by saying these figures are misleading, because private sector commissioning accounts for only six pence in every pound spent by the NHS, with a rate of increase of just one penny since May 2010. More than this has gone into commissioning voluntary “third sector” organisations, as part of a programme to involve a plurality of provider organisations, thereby increasing competition and improving patient choice.
Roberts, M. (2014). A third of NHS contracts awarded to private firms – report. London: BBC Health News, December 10th 2014.
Dr Mark Porter, Chair of the British Medical Association has commented:
“Enforcing competition in the NHS has not only led to services being fragmented, making the delivery of high-quality, joined-up care more difficult, but it has also diverted vital funding away from frontline services to costly, complicated tendering processes”.
The UnitingCare five-year £800 million NHS out-sourcing contract covering older people’s healthcare and adult community services had to be terminated due to financial unsustainability.
Cambridgeshire’s £800m NHS out-sourcing contract ends. London: BBC News Cambridgeshire / BBC Health News, December 3rd 2015.
BBC News discussion:
Pym, H. (2015). Outsourcing care – can the sums add up? London: BBC Health News, December 4th 2015.
Front Door Privatisation?
Pym, H. (2018). Plymouth hospital in ‘pioneering’ deal with private health company. London: BBC Health News, October 26th 2018.
The NHS Reinstatement Bill 2015
A number of health leaders, experts and academics have launched a campaign seeking support for the “NHS Reinstatement Bill 2015”, which would reverse some of the changes in the NHS brought about by the Health and Social Care Act 2012. This campaign (www.nhsbill2015.org) hopes to restrict the role of commercial companies and reduce competition within the NHS, with a view to ending the purchaser-provider split and re-establishing prominence of public bodies and public accountability.
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Health experts launch campaign to reverse NHS reforms. BMJ. October 6th 2014; 349: g6057.
Pym, H. (2015). MPs in bid to reverse NHS reforms. London: BBC Health News, March 6th 2015.
A brief analysis of Labour’s policy proposal for limiting profits to 5% on private sector contracts with a value over £500,000:
Pym, H. (2015). NHS: Labour’s private profits cap. London: BBC Health News, March 27th 2015.
Announcements at the Conservative Conference (Birmingham, September 2014)
The Conservatives pledged to protect funding for the NHS in England from cuts for five years:
Cameron vow to ring-fence NHS spending for another five years. London: BBC Health / Politics News, October 1st 2014.
Triggle, N. (2014). NHS budget: What we aren’t being told. London: BBC Health News, October 1st 2014.
Timely Debate Renewed (Post-Political Conferences Season)
A group of leading medical groups and charities (including leaders from British Medical Association, the Royal College of Nursing, the Teenage Cancer Trust, the Royal College of Midwives, the Alzheimer’s Society, and the RCP’s Faculty of Public Health) have asserted that health and social care services are at “breaking point”, in their letter to the Independent newspaper. An NHS deficit of £30bn by 2020 is predicted.
NHS and social care ‘at breaking point’, medics and charities warn. London: BBC News / BBC Health News, October 6th 2014.
Political Posturing (2015)
More knockabout posturing:
Labour: NHS would be left ‘unrecognisable’ under Tories. London: BBC Health & Politics News, January 4th 2015.
Further grist to the mill:
Triggle, N. (2015). NHS set for a bumpy start to 2015. London: BBC Health News, January 5th 2015.
Labour has called for the government to hold an urgent summit on how to solve pressure on A&E services:
Labour seeks summit to find A&E ‘fix’. London: BBC Health News, January 7th 2015.
A political football?
Political row deepens over A&E problems. London: BBC Health News, January 7th 2015.
Historical NHS Spending Statistics: Reality Versus Mythology
Taking “the long view” on misconceptions, misrepresentation and mythology concerning NHS funding commitments (and deficits), how many people are / were aware that spending on the NHS during the Thatcher government, far from being slashed as is commonly understood, grew by 3% per year in real terms?
Robinson, N. (2015) [BBC Political Correspondent featured on] Numbers of the Year 2014. London: BBC Radio 4; More or Less Programme, January 2nd 2015 (repeated January 4th 2015).
2015/16 National Tariff Payments Dispute
NHS Providers, which represents hospital trusts, have rejected plans for next year’s payment system. These proposed tariff reductions were designed to transfer money into services outside of hospitals and thereby improve care into the community. 80% of hospitals are in deficit however.
Triggle, N. (2015). Hospitals and NHS bosses at loggerheads over funding. London: BBC Health News, January 29th 2015.
Agency Staff, Private Finance Initiative (PFI) Schemes and Unsustainable Drains on NHS Finances
The House of Commons Public Accounts Committee (PAC) has demanded changes to make the NHS in England financially sustainable.
“From all our work across all of government, the fragility of the NHS finances causes me greatest concern”. Margaret Hodge, PAC Chairwoman.
Brimelow, A. (2015). MPs call for radical change to make NHS sustainable. London: BBC Health News, February 3rd 2015.
Payday Loans Attitude to Workforce Planning
The Royal College of Nursing (RCN) has estimated that NHS spending on agency nurses in England has increased rapidly during the past two years, to nearly £500m (last year) and could soon reach £980m per year.
Dreaper, J. (2015). NHS agency nurses spending ‘soars’. London: BBC Health News, February 5th 2015.
The Recurring Debate Over Charging for NHS Services
Customer charging on prescriptions, dentistry and spectacles was introduced in the early 1950s.
Triggle, N. (2015). Why not introduce more NHS charges? London: BBC Health News, March 11th 2015.
Pernicious falsehood or extraordinary foresight (going beyond the available evidence)?
Triggle, N. (2017). Stephen Hawking: I’m worried about the future of the NHS. London: BBC Health News, August 20th 2017.
Misunderstandings, or irresponsible scaremongering, on the subject of accountable care organisations (ACOs)?
Campaigners in court over NHS policy. London: BBC Health News, May 23rd 2018.