New report spells out cost of transforming health and care system
The LSE Lancet Commission investigated health and care services across all four nations and concluded that spending needs to increase by 4% per annum in real terms for both health and social care, meaning a £102 billion uplift by 2030/31
This would mean increasing personal tax, National Insurance and VAT by 1p until that date with further increases to tax and National Insurance to 2p after that date.
The first phase of tax rises would see someone earning £25,000 paying an extra £6 per week. The Commission argues that this is a price most people are prepared to pay and says that post pandemic: “the UK faces a once-in-a-generation opportunity to invest in the health of all its population and secure the long-term future of the NHS. Failure to re-lay the foundations of the NHS risks a continued deterioration in service provision, worsening health outcomes and inequalities, and an NHS that is poorly equipped to respond to future major threats to health.
Interestingly one of the key authors of the financial and revenue-raising proposals is the highly respected Paul Johnson, director of the Institute of Fiscal Studies who was recently appointed chair of Northern Ireland’s Fiscal Commission which is looking at ways NI could raise additional revenues.
Covid-19 was by far the biggest shock that health and social care have faced since the establishment of the NHS. It served to highlight both its strengths and weaknesses as well as the enormous challenge a health crisis poses to the entire economy.
The report identifies the following shortfalls which affected the response to the pandemic: “Failures in leadership, an absence of transparency, poor integration between the NHS and social care, chronic underfunding of social care, a fragmented and disempowered public health service, ongoing staffing shortfalls, and challenges in getting data to flow in real time.”
And remember, the pandemic struck at a time when health and social care were already being seen as being in deep crisis – struggling to meet increased demand at a time of financial constraint, a social care system at breaking point, a lack of priority for public health spending, all against the background of cuts to other public spending, much of which negatively affects health.
Although the NHS is rightly regarded with pride across the UK, what is not so well known is that our spending on it is relatively low compared with other wealthy countries. We spend on health 87% of the mean spend of G7 countries (excluding the US) and we have comparatively low rates of tax as well.
It is hardly surprising therefore that the Commission argues for more funding for the NHS, social care, and public health. It says this “is essential to ensure that the health and care system can meet demand, rebuild after the pandemic, and develop resilience against further acute shocks and major threats to health.” And it calculates that the tax rates it proposed would still only lift us to 98% of the G7 mean spend.
There’s also a reminder that a healthy population is directly related to a strong economy in general and that the sheer scale of the health sector means it is also crucial because of its spending power and employment. Across the UK one in eight people work in health and social care.
The report observes that public health investment has been neglected – despite clear evidence that prevention is far cheaper than treatment. In that spirit it also calls for significant new funds for improving population health and addressing health inequalities (which are the starkest in Europe).
It may well be the case that the public would be supportive of increased spending in health and care and prepared to fund it through more tax.
But that will require strong, united leadership from politicians of all parties. They need to make the case and have the courage to vote for it. If they can’t do this in the immediate aftermath of pandemic perhaps they never will.
And the report has some important recommendations that policy-makers would be wise to follow.
Transforming health and social care is not just about how much you have to spend but how you spend it too. Social care is the bedrock on which health services rest. It is just as important to invest in it as well and there needs to be integration between the two.
We have that in Northern Ireland on paper, but the report is brutal about how that works in practice: “Although health and care services can be structurally aligned, Northern Ireland shows how other barriers, such as an overemphasis on the hospital sector, little interoperability between information systems, a scarcity of leadership at all levels of the system, and weak political will can reduce successful integration.”
That’s certainly a check list for the Department and Trusts to work their way through.
There’s also a passage on social care that may raise alarm bells in the Third Sector, where it expresses concern over: “the heavy reliance on the charitable sector for the provision of care, including dementia support, mental health services, and community palliative care. In the case of charitable services for the provision of palliative care, this reliance leads to patchy, fragmented, and poor quality care towards the end of life for many individuals.”
It is interesting to see the report putting a strong emphasis on workforce issues. First is putting in place the support required for staff as the pandemic comes to an end. It states: “The contribution of health and care staff during the pandemic has been immense but has come at great cost, with several hundred staff deaths, approximately one in 10 of all COVID-19 infections being in patient-facing health and care workers, and many staff having substantial psychological stress.”
Unless that is adequately addressed it seems inevitable that more and more will choose to leave a service which already has a troubling number of unfilled vacancies.
And it is encouraging to see the report stressing the importance of the vast army of unpaid carers (9.1 million across the UK at the last count) without whom the system would collapse.
The report calls for a more sophisticated approach from the various countries and regions to the workforce. All do workforce planning but this tends to concentrate on the supply side ( – not just looking at the supply side (recruitment and retention). That’s fair enough in so far as it goes but the report wants to see a greater concentration on the demand side (demography, morbidity, use of health and care services etc). This should also be coupled with an approach which looks at required skills rather than professions, with an eye to developing more flexible roles to cope for emerging needs.
This report is the culmination of four years work and is unusual in that it looks across all of the UK. It is also very clear in the contention that the different countries of the UK have much to learn from each other and that co-ordination between them is vital – a point which can only be reinforced by the chaotic lack of co-ordination during Covid-19.
It has been well-costed and the figures it is calling for do not appear to be excessive – indeed the uplift would lead to health spending which is still lower than most other wealthy nations. Surely it has to be taken seriously by policy makers. After all if not now, after all we have been through, then when?
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