The NHS consumes the lion's share of public service spending – just under one pound in five of all government spending, excluding welfare payments. That's the same as all spending on education and defence combined. Over the decades, as the economy has expanded, the spending of choice – as in all countries – has been health. But now, following the epically calamitous global financial collapse and ensuing recession, the pressure on public spending is intense. The mismatch between government revenue and spending has to be brought back to sustainable levels of borrowing.
Whichever party forms the next government they will be faced with hugely difficult decisions about tax and spend. But all political parties know that health – the NHS – holds a special place in the electorate's hearts. The British Social Attitudes Survey has relentlessly confirmed year after year that for over a quarter of a century the public's number one priority for government spending is health.
So, what's a prospective government to do? Here is what we currently know of each of the three main parties' plans for health spending over the next few years.
- Labour: Alastair Darling's Pre-Budget Report and March 2010 Budget stated that 95 per cent of the NHS budget would be increased in line with inflation for the two years 2011/12 and 2012/13. The implication of this was that 5 per cent would not be protected. So, overall, Labour are promising a small real reduction – how small depends on the scale of cuts in the 5 per cent of the budget not protected.
- Liberal Democrats: The intention is to match the current government's spending plans for the NHS which are, well, see above.
- Conservatives: The promise is a real rise in funding. There is no indication of the scale of any increase so presumably this could mean anything from very little to, well, somewhat more than very little. But even a small real rise – 1 per cent? 2 per cent? – will be hard to find given the consequences for other spending departments.
But as the UK nudges nearer to spending one pound in every ten of its entire wealth on health care perhaps the time is getting closer when we need a rethink of the narrow paradigm that more must be spent on health care.
Better use of the NHS budget is now the number one priority. But perhaps there are also other things that deserve our attention. For instance, based on The King's Fund's 50 per cent social care partnership model, we could start to move to adequately fund the social care needs of older people over the next five years for the equivalent of a real rise in NHS spending each year of just 0.6 per cent. Worth thinking about.