Hunting for a good line on NHS funding

It looks as if the Tories are trying to get out ahead of the NHS funding debate as the “short” general election campaign finally gets under way (after what feels like a very, very long run-in).

The Guardian is reporting that health secretary Jeremy Hunt has promised that the Conservatives will find an additional £8 billion for the health service over the course of the next Parliament, if they are returned to power.

That would, in theory, “fully fund” the ‘Five Year Forward View’ plan drawn up by NHS England chief executive Simon Stevens in October to bridge the £30 billion gap between funding and demand that could otherwise open up by 2020-21 (see below).

Except, of course, that even the most basic maths suggests there is £22 billion missing from those two figures. The 5YFV says this can be closed by improving public health and introducing more efficient service models.

But in doing so, it makes some heroic assumptions. The NHS has known that it was going to face a gap between funding and demand since 2008 (see the ‘Nicholson Challenge’ posts below). It could have closed this gap by now if it had managed to make efficiency savings of around 4% a year; but it has got nowhere close.

At a King’s Fund breakfast meeting ten days ago, Chris Hopson, the chief executive of NHS providers, warned that trusts were looking at a deficit of £2.5 billion in the coming financial year, and that some would literally run out of money.

That, he warned, will leave ministers facing competing demands for any cash that is available, with one set of voices demanding a bail out of the acute sector, and another lobbying for pump-priming for the 5YFV.

Oh yes and money will also have to be found for any daft election pledges; such as Andy Burnham’s promise of thousands more staff and David Cameron’s sudden commitment to 24 hour working.

Interestingly, but not surprisingly, nobody is talking about public health, since politicians don’t like admitting the link between growing ill health and growing inequality, which really would require some creative policy to tackle, and the electorate doesn’t like being told to smoke, drink or eat less.

So that bit of the Stevens plan is a bit of a dead duck. Meantime, its big hope, that creating ‘integrated’ services, by letting hosptials take over community, primary and social care, or by letting GPs expand run lots of the service around them, will save lots of money is, at best untested (the National Audit Office might say tested and found wanting, see below).

Still, £8 billion sounds like a lot, if you don’t worry about this kind of detail; which Hunt has said will all be worked out in the “summer” – by which time the election will be well behind him, and he’ll probably have moved on to bigger and better things.

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