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Reports vs policy

Hard-wired GP

Luke Koupparis

Thursday, 07 June 2018

AdobeStock_124144255_v2.jpgEveryone seems to be saying that the NHS needs more cash and loads of it, along with a long-term commitment. Three Health Tanks have just written to Theresa May suggesting the NHS needs a bare minimum of 4% to prevent further deterioration in patient care. At the end of May a report was produced by the Institute of Fiscal studies and the Health Foundation suggesting that each household would need to fund an additional £2,000 to keep the NHS from imploding. So, it’s not just the medical staff now suggesting we need further investment, but quangos whose sole job it is to work this stuff out.

Even Jeremy Hunt is on the case for additional funding recently stating that the public are ready for tax rises to fund it "provided they can see that it is not being wasted". It sounds like his comments have caused a bit of a furore in the Treasury which is hell bent on making the books balance and hence not keen on relaxing their purse strings.

Mrs May has promised to put a long-term strategy in place for NHS funding and we may hear about this quite soon, if the reports are to be believed.

However, I see the latest Think Tank joint letter suggests that reform will be required to adopt new models of care adapting to a changing population.

More reform I hear you cry, what reform is going to be required if the NHS gets more cash? Haven’t we had enough NHS reforms to last a lifetime?

I would wager that If any cash is forthcoming, then it will be linked with implementation and uptake of new models of care. I guess these new models will include the further creation of super surgeries possibly integrated with secondary care services. The dream of creating an out-of-hospital environment primed and ready to stop even the most determined elderly patient bouncing into hospital as soon as they even dare to show a whiff of a urinary tract infection.

My other concern about all of this is that the Government might come up with a funding settlement, but they will simply raid another budget to pay for it. They might simply choose the social care pot. However, syphoning money from here will go no way to solve the current NHS crisis. Worse still, they might completely marry the health and social care budgets, using clever accounting and soundbites to publicise they have increased the NHS budget, but in reality just cutting and pasting a few columns in their Treasury (how to fund the NHS on a shoestring) document.

It really isn’t looking great for social care. Only earlier this year, the King’s Fund stated in a report that there was little sign of a long-term solution on the horizon calling it ‘one of the greatest unresolved public policy issues of our time’. The conservative party will also be very wary of social care reform having been badly burned in 2017 by Theresa’s proposed means test plus cap on fees (dubbed the Dementia Tax). So, it is unlikely we will have anything radical in the pipeline for social care.

Are we going to be presented with a plan for the NHS? Undoubtedly, we are, and quite soon.

Therefore, in preparation for this, and in the unlikely event that Mrs May stumbles upon this article, I want to give her some clear advice on how to tackle it for any last-minute edits. Here goes:

Dear Mrs May,

  1. If you want this NHS funding issue to go away, you are going to have to come up with a clear plan that includes one with enough (real) cash in it.
  2. There is a public appetite for having ringfenced money to pay for the NHS, so you are going to need to include a mechanism for getting this money, most likely tax.
  3. Please don’t raid the social care budget thinking you can just move a few deckchairs around to fix the problem.
  4. Don’t think that linking this money to sweeping reforms will do anything but create faceless large organisations offering endless skype consultations with a different doctor each time. That will be a waste of money.
  5. If you get this right, then we can maybe start to have a world class health system that Jeremy keeps saying that we need.
  6. If you get this wrong, then the NHS will continue to be a right pain in the proverbial for you for years to come.

Looking forward to seeing the draft report when you have it.

All the best…

I think that should do it.

(Note to site editor, if you get a Mrs May trying to post a comment then let me know...)

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Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group, LMC representative and chair of the locality provider group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist and likes to ski with his children.
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