Is more money alone the answer for the NHS?

Rumours abound that more money is to be found to coincide with the 70th Anniversary of the NHS in July. 

However, with the needs and expectations of an aging population rising, it seems germane to ask the question: is the solution simply to provide more money, or rather should the NHS be asking the question – exactly which services should the NHS be providing free of charge? The costs of ‘cradle to grave’ comprehensive medical care, ‘free at the point of delivery’ for a population of more than 65 million people, seem certain to rise inexorably. Just as an example, state-of-the-art care for each individual lung cancer sufferer now exceeds well over half a million pounds.

In addition to increasing costs, demand for NHS services is also rising, putting pressure on services, and on those who provide them. Almost every article in the health pages of popular newspapers seem designed to drive more patients to see their GP. More and more investigations, including expensive CT and MRI scans, are being requested, simply to reassure the patient (as well as to protect the doctor from censure) that all is well. Add to that, the repercussions of obesity crisis, pressing issues of mental health and the lack of provision of social care, it is easy to understand why the NHS at 70 – like many of us – is creaking at its aging joints. While increased funding would undoubtedly be welcome, surely the time has come to address of which services the NHS should and should not provide?

Do please add your thoughts and suggestions to this blog. 

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Comments (12) Add yours ↓
  1. Greg shaw Consultant urologist

    If you are to have a service that provides some services but not others there is likely to be very difficult discussion about what services are included.

    We might consider an alternative model like that which exists in Germany. There, a basic procedure is provided by the state health service with patients paying a supplement for more expensive but desirable options (eg, where they want a robotic rather than open prostatectomy). The Australian model is similar, I believe, with private insurance or self-paying wealthy patients funding the more expensive desirable extras, with state provision of a reasonable but cheaper option for those who need it.

    I am sure other models exist around the world and it’s clear, even to the most ardent supporters of the NHS, amongst whom I include myself, that the inexhorably growing demands cannot be met and that we must choose a strategy and adapt.

    May 23, 2018 Reply
  2. Mike Kirby Professor

    Sounds as though we will all be paying more tax.
    That’s fine as long as it goes where intended!!

    May 24, 2018 Reply
  3. Roger Kirby Professor of Urology

    Theresa May has promised to put up a long-term plan for funding the NHS and suggested that fresh cash could be made earmarked for the cash-strapped service later this year.

    Speaking at a thinktank event in London, Mr Hunt said: “Poll after poll shows that they do recognise that through the tax system we will end up having to contribute more and there is a willingness to do that, providing they can see the money going to the NHS and providing they can see that it is not being wasted.

    “From the chancellor’s point of view, he well understands that. He has a responsibility to make sure that the funding for all public services is within what the country can afford and of course that is important because the NHS depends on a strong economy more than other health systems because the vast majority of our funding comes directly from tax coffers.”

    May 25, 2018 Reply
  4. Bruce Montgomery Mr

    With patients now presenting with multiple problems, often age related, how can we be expected to fix everything. Medicine has become risk averse and to blame when things go wrong. We need to reconsider what the NHS is there for and sort out the conflict between health and social care

    May 28, 2018 Reply
  5. Christopher Smallwood Former chairman, St George's University Hospitals NHS Foundation Trust

    The NHS is effectively already withdrawing from the provision of services now as a result of financial pressures – not just declining to provide particular therapies, but more basically, as over the winter, declining to perform elective surgery! The problem with this is that affluent people continue to receive the health care they need through the private sector, whereas poorer people do not.
    In my view, it would be more equitable for everyone not receiving state benefits to contribute something to the costs of their health care, bridging the financial gap that way and enabling the NHS to continue to provide a comprehensive service. The French system provides a model. 90% of the population contribute to state-organised supplementary insurance, which they draw on as the need arises. They are presented with a bill for part of the cost of their treatment (the proportion they pay depending on a menu of charges reflecting the seriousness of their condition), with the state picking up the rest. Since everyone contributes and everyone is treated, the system is equitable even though health care is not free.

    June 5, 2018 Reply
  6. Sebastian Kraemer Retired paediatric liaison psychiatrist

    ‘cradle to grave’ means start at the cradle, indeed just before. We know that perinatal nutrition and stress can affect the future offspring for life but there is no proper coordination of care. If obstetricians and midwives cannot decide – ‘is it mental, is it physical, is it social?’ – that just means that no-one will intervene until there is a diagnosis and a pathway to follow, which may be too late, or never

    These two letters summarise the problems.
    Lancet 2015
    BMJ 2018

    Money must be spent on prevention at the earliest possible stage, even when there is not hard RCT evidence about precisely what to do.

    A duty of care trumps gaps in systematic research

    June 7, 2018 Reply
  7. Roger Kirby Professor of Urology

    Theresa May is poised to give the NHS a £4 billion-a-year boost funded by borrowing, income tax and a Brexit dividend.

    The Prime Minister is on Monday expected to announce that she will boost NHS funding by around 3 per cent a year as part of a “multi-year” settlement to mark its 70th anniversary.

    She is expected to say that the rise will be funded in part by a “Brexit dividend” – one of the Leave campaign’s central pledges during the EU referendum.

    June 15, 2018 Reply
  8. Roger Kirby Professor of Urology

    A majority of voters would pay more tax to provide a funding boost for the NHS, a new poll has found. Two thirds – 66 per cent – of voters, including 63 per cent of Conservatives, would be willing to pay 1p more in the pound in income tax to provide a funding boost for the NHS, according to a YouGov survey.

    It comes amid speculation the prime minister, Theresa May, is poised to announce a major increase in health spending to mark the 70th anniversary of the NHS. Unconfirmed reports in several newspapers suggested Ms May could announce a cash injection of between £4bn and £6bn a year as early as Monday.

    The boost would be funded by borrowing, income tax and a hoped-for “Brexit dividend” from leaving the EU, it was suggested. Downing Street declined to comment on reports ministers were considering raising some of the cash by freezing the thresholds for the standard and higher rate of income tax from April 2020. Yesterday, a report by former health ministers Lord Darzi and Lord Prior argued the case for guaranteeing growth of around 3.5 per cent a year in health spending over the long-term to ensure the NHS is fully funded.

    June 16, 2018 Reply
  9. Roger Kirby Professor of Urology

    A huge increase in National Health Service spending over the next five years is expected to be announced by Theresa May in a speech tomorrow. The numbers are larger than expected and, significantly, allow the prime minister to say that she will deliver the resonant figure on the side of the Brexit bus, an increase of more than £350m a week. Indeed, by 2023 public spending would be £385m a week more in real terms than today.

    Of course, the increased spending will not come from any “Brexit dividend” – the costs of leaving the EU are almost certain to be greater than any contributions saved, as Paul Johnson of the Institute for Fiscal Studies has explained. Nor does it fully meet the demand by Simon Stevens, the NHS England chief executive, for rises of 4 per cent a year, but 3.2 per cent a year is significantly above the average real increase of 1.3 per cent a year since 2010.

    June 17, 2018 Reply
  10. Roger Kirby Professor of Urology

    Theresa May has refused to say which taxes will rise to pay for her £20bn a year NHS boost, amid a storm of criticism over her claim of a “Brexit dividend” to part fund it.

    Pressed on her admission that tax hikes will be needed, the prime minister gave no details, saying only that “we will be contributing more as a country”.

    Meanwhile, independent experts and a senior Tory MP dismissed Ms May’s claim – echoing the much-derided Leave campaign – that the government would have extra cash from leaving the EU.

    “Don’t even begin to swallow any rubbish that this will be some Brexit bonanza,” tweeted Sarah Wollaston, the Tory chair of the Commons Health Committee. “In reality the tax rises & borrowing will need to be higher as a result.”

    Paul Johnson, the head of the respected Institute for Fiscal Studies (IFS), said the government had accepted that Brexit would swipe £15bn a year from revenues – or £300m a week.

    Furthermore, the “divorce bill”, plus commitments to replace Brussels funding in key areas, would swallow up all of the returning EU contributions until 2022. “There is no Brexit dividend,” Mr Johnson said.

    June 18, 2018 Reply
  11. Roger Kirby Professor Of Urology

    Recent analysis of @nmcnews data shows that month on month, registration of new nurses from the EU has flatlined between the #Brexit referendum result in June 2016 and April this year.

    Read the full story:…

    July 29, 2018 Reply

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