Andy Silvester is Campaign Director at the TaxPayers’ Alliance.
One could be forgiven for thinking that at any minute, the suspiciously tangerine auctioneer David Dickinson is soon to pop out with a camera crew. Such is the nature of the start of the election campaign, in which all parties are engaged in a bidding war around NHS spending.
The Tories have promised an extra £2 billion spending, Labour have promised £2.5 billion in addition to a thousand more nurses north of the border, but it’s the Liberal Democrats leading the way with an extra £8 billion of funding. With 120 days until the gavel comes down, it remains to be seen how high this eBay election auction will go.
But here’s the rub. If the NHS does not find the efficiencies it needs to, and the population ages, then the bill will have to keep going up, in perpetuity.
The budget for the NHS nearly doubled in real terms between 2000 and 2010. The budget between 1979 and 1997 NHS spending rose at around 3.2 per cent in real terms, but from 1999 and 2008, the budget went up by an average 6.3 per cent.
Where did the money go? My colleague at the TPA Alex Wild has run the numbers, but it’s quite clear that the vast majority of the cash went into increased headcount and higher pay. According to the National Audit Office, however, though “there has been significant real growth in the resources going into the NHS… the evidence shows that productivity in the same period has gone down, particularly in hospitals.” Let us not forget – whilst that budget was increasing, patients at Mid-Staffs were drinking from vases in corridors.
That’s what makes the bidding war so depressing. When they talk about the Health Service, politicians focus too much on inputs – how much is spent, and who is delivering it – rather than outputs; in short, whether the Health Service is doing as good a job as it can do for the people who rely on it and, yes, pay for it.
Call me a traditionalist, but I’m of the opinion that people coming out of hospital healthier than they were when they went in should be something of a priority.
And on that front, our “envy of the world” is not doing too well. TaxPayers’ Alliance research in 2011 showed Britain does not compare well to European neighbours when it comes to survival rates. Though some international comparisons have ranked the Health Service well in certain areas, as Matthew Parris noted this weekend, those measures tend to be skewed towards an NHS-style healthcare model.
The Guardian’s coverage of one report, from the Commonwealth Fund, contains a line for those with an appreciation of deeply dark tragi-comedy: “The only serious black mark against the NHS,” it said, is “its poor record on keeping people alive.”
Rather than having a critical discussion about how we will fund the NHS (in whatever form) as our population ages, we have a competition to see who can pledge more borrowed money and who can fit as many NHS badges on their suit lapel. Instead of looking for efficiencies, and redirecting existing resources towards the areas of the NHS that are overstretched and away from those that are not, there are just commitments to sign another cheque.
The childish, uncritical way in which we look at the NHS blinds us to the fact that current model may very well not be sustainable as our population ages.
Politicians are keen on alarmist warnings of “24 hours to save the NHS” – indeed, the Shadow Health Secretary Andy Burnham has warned us of impending doom so many times over the course of this Parliament that it appears he is operating in a different space-time continuum to the rest of us. But they’re less keen on asking why our cancer survival rates are worse than Malaysia’s, and why we have fewer MRI units per head than Slovakia.
More money for nurses, hard-working though they may be, won’t help people stuck waiting for tests for weeks on end because we don’t “sweat our assets” at the weekend, nor will A&E waiting times be brought down if we continue to see one in four GP surgeries shut up shop for one afternoon a week.
It would perhaps be naïve to expect politicians to be honest five months before an election. But if politicians really care as much as they say they do about the principle of the NHS – good quality, taxpayer-funded healthcare free at the point of use – then they need to come up with something more substantial than soundbites and spending pledges. The people who rely on the service, and will rely on it in the future, deserve better.