Cross-party approach to the NHS and social care

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When MPs from different parties come together to argue for more funding for the NHS and social care, it is time to sit up and take notice.

Last week’s statement by Nick Boles (Conservative), Liz Kendall (Labour), and Norman Lamb (Liberal Democrat) could not have been clearer. Spending on the NHS and social care needs to increase by substantially more than inflation over the next 20 years and should be paid for by a dedicated tax.

This initiative follows hard on the heels of a letter to the Prime Minister in March from 98 MPs, including 21 select committee chairs and senior backbenchers drawn from across the political spectrum. The letter made the case for establishing a parliamentary commission on health and social care to examine, among other things, future demand for care and funding options. MPs who signed the letter argued that a cross-party approach to these issues was urgently needed and that the commission should report before Easter 2019.

Politicians are coming together to speak out because of growing pressures on the NHS and evidence of widespread public concern. Survey evidence shows that the public is increasingly anxious about the state of the NHS and that there is support for tax rises to increase funding. Tax rises are now backed by a majority of supporters of all the main parties, including 56 per cent of Conservative supporters, up from 33 per cent in 2014.

MPs have also been emboldened by the existence of a minority Conservative government reliant on the support of the Democratic Unionist Party to take forward its programme in parliament. A government weakened by the loss of its majority at the 2017 general election creates opportunities for MPs and peers to exert influence. The Prime Minister’s surprise commitment to deliver a long term funding settlement for the NHS is evidence that the concerns of MPs and the public have been heard.

New plan

Attention will now focus on what the Prime Minister says around the 70th anniversary of the NHS, when an announcement is expected on the scale of the promised funding increases. The Prime Minister may also use the anniversary to set out the government’s goals and priorities for how additional funding will be used. A more detailed plan is expected to follow later in the year, following engagement with key stakeholders and outlining what the NHS will deliver with the resources the government is able to commit.

Ensuring that the NHS gets back on track in delivering national waiting time standards and balancing its finances are certain to be among the government’s top priorities. Equally important is to continue the work that has started to achieve parity of esteem for mental health services, increase the share of spending on general practice, and make improvements in cancer care and urgent and emergency care. The new NHS plan will have to make credible commitments on how to secure the workforce needed to deliver improvements in care.

Another key priority should be to earmark funding for investment in new care models better suited to the changing needs of the population. The pressures facing the NHS will not be relieved by doing more of the same, and some of the care models that have evolved from the NHS five year forward view are helping to moderate rising demand for care in hospitals and are delivering more care in people’s homes and closer to home. Accelerating the adoption of new ways of working, with an emphasis on the prevention of illness and the integration of care, should be the centrepiece of the new plan.

A constant refrain in the arguments put forward by MPs across the political spectrum is the need for social care to receive additional funding as well as the NHS. The Prime Minister’s decision to add social care to Jeremy Hunt’s job title and to put him in charge of work on the promised green paper on the future of social care shows that this issue has risen up the government’s agenda. The big prize on offer is a new settlement for the NHS and social care, building on the report of the Barker Commission in 2014, and recognising, as Nick Boles has observed, that the country has arrived at a second Beveridge moment

If the political will exists to work towards a new settlement, the hard question will be how to pay for it. Ideas advanced by the main parties, like former health secretary Andy Burnham’s 'death tax' in 2010 and the Conservatives’ 'dementia tax' in 2017, have failed to attract support, suggesting that a cross-party approach is needed this time round. The difficulty will be to persuade party leaders to follow the example of their backbenchers and find common cause. The habits of adversarial politics die hard even when so much is at stake.

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