The politics of reform of the NHS have never been easy. It was not easy for the Blair government that I was a small part of and it has not been for the coalition government.
But running away from that controversy has now placed the medium-term politics of the NHS in a very odd place.
Between now and 2020 both main political parties have pledged to:
- maintain the basic principles of a free service paid for out of general taxation with equal access for all
- not have another ‘top-down reorganisation’
- keep to the same level of resource
- recognise that there will be an increase in demand from older people with long term illness of about 20 per cent
- create a new universal coordinated care model to abolish the fragmented health and social care services of the moment
And all of this is apparently going to happen without any major reforms of the existing system.
This drives leaders within the NHS to distraction since they know that all of these goals can only be achieved with a great deal of change.
That is why today’s pamphlet from Norman Warner and Jack O’Sullivan ‘Solving the NHS care and cash crisis’ is such an important contribution to the future of the NHS.
The main political point that they make is that if you genuinely love the NHS and you genuinely want to see it thrive over the next 30 years, then you have to help it make some very hard choices and provide political support for it when it makes those choices.
If on the other hand you are frightened of the political controversy that real change and reform will create and that leads you to defend the status quo for the NHS you are probably defending the NHS into an early grave.
Warner and O’Sullivan outline one of the first real political arguments for overall reform of the NHS for over eight years (for reasons I never understood Andrew Lansley never really constructed an argument for his reforms).
There will be a row. And that will be a good and necessary row.
The changes to the health and social care model of delivery they argue for are thorough. They recognise that many of those places that we call hospitals will be providing health care in the future, but in a very different way.
But the main controversy will be about funding. They argue for extra resources for the NHS that are to come from three sources
- taxes that are health improving
- taxes related to health consumption and ability to pay and
- changing entitlements and increasing co-payment
Politically the first two will appeal to the left and the third will horrify the left.
Higher taxes on alcohol could provide hypothecated taxes just for the NHS.
An increase in the percentage of people who pay inheritance tax could go to the NHS.
They then argue for changing universal entitlements and some limited co-payments.
I do not agree with these three points for very different reasons.
I think any limitations of entitlements for the NHS and introduction of co-payments will begin to hack away at the strong popular sentiment that exists for the institution. And, being the same age as the NHS, I do not want that to happen.
But my worry about ‘finding more money for the NHS’ is that the very promise of more money will once more reduce the pressure on the NHS to change the way in which it provides services.
The innovation that will be required from the NHS and social care to follow other services and provide significant better outcomes for the same resource will be diminished if more money is uncovered.
Paul Corrigan was a health adviser to the last Labour government
Photo: Chris Jones
Progressive centre-ground Labour politics does not come for free.
Our work depends on you.