Will Money Alone Fix The NHS?

In winter when the weather is poor it is easy to predict a crisis in the NHS. There was trouble last year and again this year to coincide with winter flu and its difficult although predictable pressure on services.

Finding money

Recent crises in the NHS have come at a time when spending has increased, albeit not enough to address the escalation in demand. But it would be wrong to assume that money alone will avert a future crisis or that there will be a windfall as promised by those in favour of Brexit. Funding for the NHS may in fact fall, as uncertainty leads to greater requests from other areas of government that need finance. Regardless of the detail however it is likely that the health service will devour a bigger slice of public spending in the future.

There is also the suggestion that a stand-alone ring-fenced tax should be introduced to increase funding but such an approach may not raise the necessary annual amount. It may also fail to provide the required flexibility to meet spending priorities as they vary depending on differing levels and types of demand.

The real issue is that while spending on the NHS has increased it is not doing so at a sufficient rate to match the burdens placed upon it. There is of course a graver question about whether spending will ever meet the needs of an aging population and advances in what is medically and technically possible to preserve and prolong life.

Finding solutions

There are of course solutions but none are easy to sell to the public or implement in an already stretched and stressed organisation where fire fighting is the norm and job satisfaction a past luxury.

The first solution is to raise extra money through taxation and other means but there are limits and they fall below what is needed to fix the problem. Taxation and the introduction of charges for services will not meet the demands of the NHS, as no amount of finite funding will address its current infinite provision.

The second solution is to make the NHS more efficient, which can only be done by a mixture of good management and managing public expectations. Efficiencies alone however will not fix a system that needs leadership to align its strategic vision and everyday work practices.

The third solution is to agree what the NHS can and cannot do, as it is necessary for all organisations to focus on their core offering to avoid the negative effects of mission creep. A review of what the NHS provides and will provide in the future is a necessary part of any solution, as it is impossible for the service to continue to be all things to all people.

The fourth solution is to ensure that high-level policies and targets are decoupled from short-term political decision-making and linked to common sense on-the-ground management practices that work for staff and patients.

The trick of course is to deliver each solution in a coordinated way through skilled managers in the context of an overall long-term vision for the service, as any single solution will not succeed.

So, it’s no surprise the NHS needs more money but it is important to recognise that it needs more than money to avoid stumbling from one crisis to the next.