Can the NHS afford the healthcare we want?

The NHS is rarely far away from a crisis. Even so, the last few months have been particularly tough. The junior doctors’ strikes have grabbed the headlines, but perhaps even more worrying for the future of the NHS is the state of its finances. Trusts are falling deeper into debt, yet the biggest budget squeeze is still a year away. It may be time, then, to rethink the way the health service is funded.

The subject was tackled by a panel of eminent doctors and journalists at a recent Spectator lunch. The question was: ‘Can the NHS afford the healthcare we want?’ a strong consensus held the answer was no and that the NHS needed more money to cope with dramatically rising demand. That was the easy bit. The harder question was how the money should be raised.

The attendees were Professor David Haslam, chair of NICE, Professor Jane Dacre, president of the Royal College of Physicians, Dr John Giles, medical director at Benenden Hospital Trust, Fraser Nelson, editor of The Spectator, Hugh Pym, BBC health editor, Dr Mike Smith, trustee of the Patients Association, Daisy McAndrew, former economics editor at ITV, Chris Walters, chief economist at Monitor, which regulates health services in England, and Dr James Kingsland, president of the National Association of Primary Care. The discussion was chaired by Andrew Neil, chairman of The Spectator magazine group.

An early suggestion was to introduce charges. It was pointed out that in Sweden, one of Europe’s most left-wing countries, no one thought twice about paying the equivalent of £30 or £50 to see their GP. The NHS, it was argued, should be better at harnessing funds from the relatively well-off. Charges would also have the benefit of damping down demand.

Not everyone agreed. Such charges would raise little, it was argued, given all the exemptions that would be required. And they might lead to some patients not seeing the doctor when they really should. In Australia, it was pointed out, the policy had backfired, with patients flocking to A&E instead. Charges, it was also argued, might be seen to undermine the fundamental principles of the NHS.

For some the problem was that, when the price remained zero, demand would be infinite — and no amount of funding would be enough to meet it. For others the fact that the price was zero was the whole principle upon which the NHS was founded.

It was suggested that ‘nudging’ could be deployed to encourage a more sparing use of resources — patients could receive texts saying what proportion of people in their area turned up for their appointments.

Discussion focused on how money could be saved. One area seen as having major potential was IT. It was ridiculous, said one panel member, that doctors were still using faxes and writing notes by hand. Another idea was to invest more in GP surgeries. A decline in the number of GPs had contributed to an alarming rise in admissions to A&E — a much more expensive place to treat patients.

Proponents of more taxation, or even a hypothecated health tax, pointed out that an entirely taxpayer-funded system was better value for money. They argued that the quality of a health service depended largely on how much funding it received, rather than the model it adopted.

There were problems here, though. It was noted that, while voters may say they will happily pay more for the NHS, their actions in the polling booth tell a different story. Politicians, meanwhile, had no appetite for doing ‘anything other than trying to muddle through’.

There was one point, though, which won broad agreement. The situation was going to get worse. In the next 18 months, it was said, something would happen that would force the funding crisis on to the front pages. Then muddling through might no longer be enough.