Frank Field, Member of Parliament for Birkenhead, speaking at our 2015 annual conference about the financial pressures on the NHS.
This presentation was given at The King's Fund annual conference on 19 November 2015.
First of all, while everybody in a way is a grateful for the ring fencing, we know that that nevertheless has resulted in the slowest real growth in public health expenditure at any time since 1948.
Nobody now would set up a structure of public health that was set up in 1948, in that the needs of ’48 are very different from the needs today. As you know, we have an ageing population and many of us, thank God, are taking a long time to die.
Even if we were starting from year one, never having efficiency savings before, the idea that during this period one can deliver £22 billion of savings on top of everything else, it just seems to me to be the makers of dreams or of nightmares, it’s not real politics.
That’s not to say, that one shouldn’t be seeking that or that we shouldn’t in fact be anxious to cover the amount of work we do and better at less cost. But I don’t think it’s on, given where we are in the health cycle. We do not know where the £8 billion is coming from, how it’s going to be delivered by the government.
But the fact to which there seems to be no commentators that have taken account of has been our open borders policy. If we look at the period from 2010 to the Office of National Statistics estimate of population growth by 2020, the numbers of people in this country will have grown by 4.5 million people. And I think the combination of all those forces will begin to operate with volcanic explosions in different parts of the health service.
And there will clearly be the period that all government goes through when it pretends this is localised, it’s a difficulty, managers have failed, doctors aren’t working hard enough, all of those. But there’ll come a point when the arguments, but more importantly the health service doesn’t stack up. And the difficulties are, of course, that the government gave, I’m sure in good stead, promises about increasing of taxation, but there will be a need for a new source finance.
We’ll have a sceptical group of voters and therefore if we are going to look to this base, then actually we need a new deal for the health service, its governance, its structure, its sense of ownership.
And what I would propose as one of the ideas to debate now because events will force mega reform by the end of this parliament and what I would propose to the government as one way in which people can read their lips about taxation, would be specifically to introduce a national insurance health tax. We should actually move to establishing a NHS National Mutual, that membership should be based on residency and on contributions. It would therefore play a key part in erecting invisible borders, which are immensely important in the politics that I’ve already begun to unfold in Europe and in this country as well. The Governors would be responsible, first of all for seeing that money is raised specifically on a new tax base did actually go to the NHS. They would have the task of pushing reform.
I think one of the crucial functions now for The King's Fund, which is blessed with an endowment and independence, is to prepare for when the thing really begins to collapse.
You’ll have heard this from politicians before, but the figures no way now stack up, a key function now in the next couple of years before the health service breaks up under the financial implosion, is to lead that national debate on what are the alternative ways of, in one area which is on financing, which I’ve addressed, it’s not the only area we have to address, so that when the Spring tide or worse begins to engulf us, there are serious alternatives for not only the government, and we shouldn’t be too worried about saving their clothes, but also those who are most needing a health service can actually get into.