The Government is in denial on health and care funding.
Demand is rising, services are stretched, and government is sticking to a funding settlement devised two years ago to prop up an existing system that often doesn’t meet people’s needs.
This has created a situation where difficult decisions are being delegated to national and local NHS leaders who have to deliver services within the existing funding envelope.
Making tough decisions in health and care is nothing new. Even the most generous funding settlement would always be finite, and prioritising – or ‘rationing’ – is necessary. It is how these decisions are made that is important.
Recent decisions on limiting access to treatments or services appear to be unstrategic, focused on areas likely to cause least political upset, and lacking in meaningful engagement with the people who stand to gain or lose; patients and the public.
We have seen a relaxation of the 18–week referral to treatment targets, a ‘budget impact test’ that could delay new drugs being available if they cost more than a £20m threshold, an attempt to push the cost of Pre-exposure prophylaxis (PrEP) drugs on to local authorities, and a number of court cases where the NHS is seeking to not pay for certain treatments. The common denominator in many of these decisions is a lack of engagement with the people who stand to be disadvantaged by them.
A recent example is the apparent intention to stop prescribing medicines that can be bought over the counter. Millions of people are entitled to free prescriptions because, for example, they are over 60, they are under 16, they are pregnant, they are living with cancer or another long-term condition, or they are poor. For these people, no longer prescribing medicines means they will have to start paying for something they currently get for free.
NHS England is consulting on the plans currently, but already a number of local commissioners have made the decision to advise GPs in their area not to prescribe these treatments.
Sustainability and Transformation Partnerships
Sustainability and Transformation Partnerships are another example where the lack of engagement and transparency creates significant risk.
Planning all the services in an area under one STP is a sound concept, but in many areas there has been limited work to understand the needs of the communities they serve. This has created public scepticism about STPs. The risk of not engaging the public is that the current vehicle for reform of the NHS and social care – STPs – could create a system that still does not meet people’s needs.
When decisions are not made openly, the smallest voices don’t get heard and inequalities deepen. Decisions on rationing should not be based on what is easiest to cut, but on what matters to those that stand to lose out, and what will truly create a more sustainable system.
Increased funding for health and care is needed, but it must be used to deliver a fundamental change in how health and care is delivered, with a significant shift in the proportion of resources from acute care to primary and community care.
Currently, resources are still being moved in the opposite direction. A £1.8bn transformation fund was largely spent plugging gaps in hospital budgets, and new funding for social care announced in the budget is having to be used to improve hospital utilisation. The continual papering over of the cracks in a struggling system is not a long-term solution.
Without adequate funding, meaningful engagement to understand the needs of communities, and a significant shift in focus away from acute to primary and community care, the new world described in the NHS Five Year Forward View will not be realised.
Jeremy Taylor is Chief Executive of National Voices and can be found tweeting at @JeremyTaylorNV