John Appleby's election views

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Part of General Election 2010

There is perhaps an unnoticed dividing line between the two main parties on future NHS funding that needs some clarification from both Labour and the Conservatives. Alastair Darling has stated that for 2011-2 to 2012-3, 95% of NHS funding will have a cash rise equal to inflation. The implication for the overall budget is that it will be cut in real terms from 'between a very small amount' up to 5% over two years. The Conservatives pledge that they will give the NHS a real rise – but have not said how much, even approximately, nor what must be given up elsewhere to provide the money.

Whatever the result of the general election the NHS will have to plan (as it is doing) for a radical overhaul of the way it provides care in order to get more from every health care pound. The politics, let alone the practicalities, of NHS service reorganisation are fraught. Politicians need to be supportive of attempts by the NHS to improve productivity – even when the going gets tough and local services in their constituencies face change.

Tighter budgets will inevitably prompt calls from some quarters for alternative ways to fund health care. As in the past, these should be resisted. Universal services paid for collectively according to income secure the widest possible funding base and public commitment and adhere to the public’s desire for equity in health care.

How the NHS allocates its finite budget is always contentious, but the continued existence of independently produced guidance for the NHS based on clinical and economic evidence of cost effectiveness is essential. Political micromanagement of how and on whom the NHS spends its money may gain some short-term support but will ultimately lead to inconsistency, unfairness, and poor value for money.


John Appleby is The King's Fund's Chief Economist

This article first appeared in a BMJ feature ‘Election Views’ published 21 April, BMJ 2010;340:c2095.