The NHS occupies a unique place in British politics. MORI polling has shown that the most important issue to the country in this election campaign is the future of the service. As a result, as Andrew Haldenby and Nick Bosanquet have written, “Party leaders proclaim their lifelong love of it, MPs vow to fight for their local hospitals, but few dare spell out the difficult realities it faces – not least, unprecedented pressure on funding in the next few years.” But this political denial is doing no one any favours. It is time to have an honest debate on the NHS.
This honest debate should include discussion on the role that hospitals play in the health system.
The importance of change in health services can be shown by the example of coronary artery disease. Treatment used to require open heart bypass surgery – a costly and dangerous procedure which would require around a week in a hospital. Innovation now means that a more affordable and convenient treatment (angioplasty) is now available, meaning more people receive treatment and hospital stays are now only 48 hours. This treatment is being, in turn, replaced by pharmaceuticals (statins) which, when used as a preventative measures, reduces the need to enter hospital at all.
Next week’s Budget will mean that the poor state of the public finances will again come into focus. But debate around the Budget should not overlook the contribution of the NHS to the government’s financial woes. The NHS accounted for 40 per cent of the increase in inputs across the whole public sector between 1997 and 2007. Since 1997 spending on the NHS has doubled in real terms to £102 billion. One in every six pounds the government spends now goes on the health budget.
Further, while the quality and quantity of care provided by the NHS has seen some improvement over the last decade, these improvements have been less than could have been expected given the extra resources provided. Much of the increase in spending was simply absorbed in NHS inflation, with around £18.9 billion (43 per cent) of the £43.2 billion cash increase going on higher pay and prices.
The fiscal position means that governments can no longer use increases in budgets as ways to avoid reforming the NHS. This is a good thing. The unreformed NHS is not only more costly but also is failing to adjust to new medical practices and techniques. It costs us all in terms of poorer health outcomes.
Hospitals are, as Sophia Christie, Chief Executive of Birmingham East and North PCT, has noted “the medical infrastructure of the 19th.” Indeed, transferring care from hospitals to the community has been a key element of national policy for years as this has the potential to deliver significant savings and also improve the quality of care.
However, a recent report by the Audit Commission reported that NHS trusts have made “little or no in-road” in shifting care from hospitals to the community or reducing demand. A major reason for this is the unpopularity of hospital closures, with Ministers and MPs often leading efforts to block closures at their local hospitals. Examples include:
• David Cameron, who challenged Lord Darzi’s suggestion that “the days of the district general hospital are over” and claimed that the “district general hospital is an absolutely key part of the NHS”, pledging a moratorium on hospital closures.
• David Lammy, Minister of State for Higher Education, who led a march against closing the Whittington Hospital casualty department in north London.
• Hazel Blears, former Secretary of State and Labour Party Chair, who opposed proposals for the part closure of Hope Hospital in Salford.
Health systems around the world are gearing up to shift care out of hospitals and into the community. The English NHS is rightly planning to do the same thing. Clinicians are leading what amounts to a revolution in the type of services provided. Politicians would do best to engage local people in the choices facing their NHS services rather than foment short-sighted opposition to them.
The new Reform report Fewer hospitals, more competition is available at www.reform.co.uk