Wednesday 21 March 2018
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The Kings Fund Blog:The deafening silence on the funding of health and care must be challenged

The referendum on Scottish independence is a timely reminder that politics is about argument, debate and disagreement. The passion generated in the run-up to the referendum stands in stark contrast to the quiescence among the main political parties in the UK on the future of health and social care ahead of next May’s general election.

Nowhere is this more apparent than on the question of how care will be funded in future. An unprecedented squeeze has left the NHS on the brink of a financial crisis, while cuts in local government budgets mean that 25 per cent fewer people have access to publicly funded social care than at the time of the last election. On current plans the outlook for both is even worse. Politicians need to be honest with the public about the scale of these challenges and how they propose to tackle them in future.

That is why our election manifesto highlights the need for additional funding for health and social care in the short term as well as fundamental reform of funding and entitlements to care in the medium term, building on the recommendations of the Commission on the Future of Health and Social Care in England. As we set out in our election tracker, all the main parties are committed to eliminating the budget deficit during the next parliament, leaving themselves little room for manoeuvre in finding the extra funding we are calling for. But hard choices cannot be avoided if highly valued public services are to be put on a sustainable footing.

Promising real-terms increases in funding – as the Lib Dems have recently pledged to do – will not be enough. With Labour debating whether a promise to increase funding can be squared with the financial straitjacket imposed by shadow chancellor Ed Balls, and the Conservatives seemingly pinning their hopes on the Better Care Fund, the prospects for adequate funding are bleak. Further savings can certainly be found from productivity improvements but these will not be sufficient to fill the growing funding gap (see our election tracker for more on this).

In our view, more money must be linked to political leadership of overdue changes in how services are provided. In some cases these changes entail the concentration of specialist services where this improves outcomes, as in stroke care and trauma services. In other cases they involve hospitals collaborating in networks to provide access to high-quality services in the most appropriate locations. Politicians need to be much braver in supporting changes of this kind where they are supported by evidence of benefits for patients.

The Fund’s manifesto also challenges the political parties to be clear about how they will support the NHS to bring about the necessary improvements in services and in quality of care during the next parliament. We argue that there should be much less reliance on external pressures – such as targets and regulation – and much more emphasis on bringing about reform from within the NHS itself. This means investing in right kind of leadership and providing staff with skills in quality and service improvement, learning from high-performing organisations in the NHS and other health care systems.

Our advocacy of reform from within the NHS is founded on a belief that transforming care depends less on bold strokes and big gestures by politicians and more on engaging the 1.4 million staff employed in the NHS in England in a long march of improvement. The role of politicians should be strategic – determining levels of funding, setting priorities and accounting to parliament for performance – allowing leaders at the local level space to innovate and improve. Devolution to these leaders linked to transparent reporting of information on performance holds out the best hope for making the sustainable and fundamental changes on which the future of the NHS depends.

We shall be taking forward debate on these issues at the party conferences this autumn and by engaging with stakeholders in the run up to the election on the recommendations of the Commission on the Future of Health and Social Care in England. Closer to the election, we will publish our assessment of the government’s record on the reform of the English NHS and on how it has performed during this parliament.

Throughout this process our aim is to speak truth to power and to keep alive discussion of issues that are of huge importance to the kind of society in which we live and the support we are able to provide to our most vulnerable citizens. In so doing we shall be challenging politicians to make clear their intentions in order to stimulate the debate that is desperately needed. The deafening silence on future funding amounts to a failure of the political process at a time when the NHS is heading rapidly towards a deep and damaging crisis.