A notable feature of this election campaign has been the NHS bidding war between the political parties (Lib Dems outline mission to make mental health a funding priority, 31 March; Tories pledge extra £8bn a year for NHS, 11 April; Miliband vows to train 1,000 more nurses, 21 April). Promises of additional funding are welcome, but it is important to be clear about what they will pay for.
First, promises of jam tomorrow are not enough when the NHS is under severe pressure today. All the parties must spell out when their pledges of extra funding will translate into hard cash to address the growing black hole in NHS finances.
Second, the often quoted £8bn a year needed by the NHS in 2020 is the bare minimum to maintain standards of care. The pledges made so far will not pay for expensive promises to deliver, for example, seven-day working or large increases in staffing.
Third, although commitments to integrate health and social care are welcome, this will take time to deliver and will not generate savings on the scale politicians might wish for. Discussion about social care funding is a serious omission from the election debate and an issue that none of the three main parties have addressed. Suggesting that money for the NHS can also be used to prop up social care would be robbing Peter to pay Paul.
Finally, the often overlooked flipside of the £8bn is that it is only enough if the NHS can find £22bn in productivity gains by 2020. There is no doubt that the NHS can – and must – stretch every penny further. But improving productivity on this scale would be unprecedented.
As the election campaign enters the finishing straight, the NHS funding debate is in need of a dose of realism.
Professor Chris Ham
Chief executive, King’s Fund
Nigel Edwards
Chief executive, Nuffield Trust
