Asking for more money just lets the government off the hook

Would the NHS benefit from increased funding? This is the definitive example of a stupid question – of course it would. But that does not mean those who profess to speak on behalf of the service should ask for more cash.

There are two reasons why pleas of poverty, such as those that followed last week’s budget, may be good PR but bad strategy.

The first is that asking for something that is not going to be delivered undermines credibility.

Yes, “austerity is a choice” but shadow chancellor John McDonnell has made it clear that a Labour government would not significantly increase public spending, certainly not to a level that would meaningfully shift the proportion of GDP accounted for by health expenditure.

If the most left wing opposition for three decades is taking this stance, the government will not feel under great pressure to revise its approach to healthcare spending.

‘Focus instead should be on dealing with the glaring lack of a robust implementation plan to realise the efficiencies identified in the Carter review’

Calling for a boost similar to that delivered in 2002 (which was on the back of a decade of improving economic performance) suggests naivety at best.

But more importantly, calls for extra cash let the government off the hook. They allow the debate to be diverted into the “strong economy, strong NHS” cul-de-sac.

There are policy changes the NHS should be arguing for that would directly affect its bottom line and this is where efforts should be focused.

For a start, if there is any money going, however little, it should be given to social care, where the need is greater and the impact on the NHS significant.

Recalibrating objectives

What the service is expected to achieve over the next few years needs to be recalibrated. The Five Year Forward View remains an inspiring vision, which the NHS should drive towards with all possible speed, but it will now have to be implemented in a financial environment different from that conceived in 2014, and the sustainability and transformation plans currently being prepared should be expected to reflect that.

Likewise, the prime minister should lead a national debate on what a seven day NHS is and, most importantly, is not – and quite how far along that journey the service will travel by the end of this parliament.

Let us have Simon Stevens and Jeremy Hunt openly acknowledge that while there are savings to be made in the NHS, the £22bn figure is a nonsensical one, the significance of which has been allowed to grow out of all proportion. Focus instead should be on dealing with the glaring lack of a robust implementation plan to realise the efficiencies identified in the Carter review.

Mr Stevens and Mr Hunt also need to front up to their supposed friends in the Treasury and tell them to stop the back door raids on budgets that support frontline delivery, and the imposition of additional costs through national fiscal policies like the planned increase in employer’s pension contributions.

HSJ readers will be able to add to this list.

This kind of pragmatism is already being pursued by the sharpest in the health policy world. The GP “rescue package”, currently being negotiated between the government and the profession, will have extra cash attached. But – should the dialogue continue in its current direction – the greater emphasis will be placed on reducing workload pressure by simplifying contract reform to deliver greater certainty on income and reducing the burden of inspection. Get this right and it will have a much greater impact on GP motivation than a cash injection, which would very quickly be discounted as demand pressures mounted.

In the end, increasing the NHS’s budget – unless the boost is of the size delivered in 2002 – will never be more than a short term fix. The NHS deserves a more sophisticated and realistic approach to its funding concerns.