James Price is Campaign Manager of the Taxpayers’ Alliance.
We now know how much extra money the NHS will be receiving over the next few years (even if we don’t know exactly where the money will come from). Brexit will manage to dominate some of the arguments thanks to the Brexit dividend, or lack thereof, and we still don’t know exactly what the mix of tax hikes and/or increased borrowing will be. It seems that Philip Hammond should be praised for preventing a horrible hypothecated NHS tax, and Labour’s ideas of throwing telephone number-sized amounts of money at every problem should be heavily criticised for its’ irresponsibility. But what should actually be done with the money, and the NHS in general?
Paul Johnson, the IFS’ director, has said that the money will prevent another winter crisis, and will at least stop the NHS from ‘going backwards’. And spending more money on healthcare is, of course, not in and of itself a bad thing. As countries get richer, they tend to spend more on healthcare. But spending increases (and the borrowing and tax hikes that will pay for them) are not the only, or even the best, way to free up more money for the NHS.
We also need to make sure that the NHS is financially sustainable in the long term, which is especially vital as the costs of adult social care are about to get a lot higher as current demographic headwinds blow ever stronger. Added to that is the fact that the tax burden in the UK is about to hit a near-50 year high. So a lot more should be done to bring down costs rather than ask taxpayers to dig deeper still, especially when the cost of living is also so burdensome.
To that end, we should first look at further efficiencies. Despite claims that the public are ‘tired of austerity’, there remains enormous waste across all trusts. Whether it is a failure to sweat high-value assets such as MRI scanners, or the enormous amounts thrown at public health campaigns with no proof that they work, there is much evidence that increasing spending will involve throwing much good money after bad. Of course, analysis also shows that increases in spending leads to a decrease in productivity. Necessity is often the mother of invention.
Such invention is in short supply, especially as the NHS is less innovation-friendly than many continental healthcare systems. Pressure to increase the adoption of automation could lead to huge efficiencies of £12.5 billion a year, according to Lord Darzi, the Labour peer and former surgeon This would also let frontline staff focus on patient care, making the NHS ‘more human’ in the words of Steve Hilton, as well as freeing up resources for big priorities, such as cancer treatment.
That’s the kind of thinking we need in the immediate term: how can we save some money or improve service delivery so that we can allow nurses and doctors to do their jobs with more dignity and less paperwork? The TaxPayers’ Alliance will be releasing work encouraging the public sector to embrace automation, and a forward-looking perspective should be welcomed.
On the topic of forward-looking ideas, now is the time to have a serious conversation about cannabis legalisation. Praise should go to Sajid Javid for the sensible policy change to allow Billy Caldwell access to the cannabis oil that prevents his seizures. But the current prohibition of the drug is costing a fortune, leading to more health problems than it should, and not saving as much money as it could. TPA research estimates that cannabis legalisation could save nearly £900 million a year, much of it in savings for the NHS through pain relief. At the very least, we should look seriously and humanely at medical marijuana possibilities.
As well as forward-thinking ideas, we should jettison some old ones that are dragging the health service down. Take facility time for trade union officials. It should strike most readers as deeply unfair that NHS workers can decry the state of the service on social media whilst they or their colleagues are off working for trade unions on NHS time. A failure to build up skills in procurement, a crucial element in modern healthcare provision, costs trusts dear; a one per cent reduction in procurement costs would pay for 4,000 junior doctors. And the failure to re-tender construction of the Midland Metropolitan hospital is another example of poor procurement skills.
There are some structural changes that would save a huge amount of money, too. A recent TPA report found that reducing the number of NHS quangos would save around £760 million. One recommendation involved granting more independence to NHS England. Since it recently issued guidance to stop expensive prescriptions for gluten-free quinoa and anti-dandruff shampoo, this should be encouraged. Cutting down on prescribing such things, not to mention paracetamol, would save a lot more and encourage people to think about prescriptions in a different light.
Whether this cash injection is the magic bullet the NHS needs is, in isolation, unlikely. And time will tell whether we should look at continental models for free-at-the-point-of-use healthcare without the autumn, winter and spring crises, or some of the worst avoidable deaths and cancer survival stats in Western Europe. But some of the reforms listed above would improve the quality of healthcare, save taxpayers money and set the NHS on a more long-term footing. Whether this kind of heresy can be tolerate with regards to the UK’s national religion (or the closest thing to one we have) remains to be seen.