In an interview today (16 April), Sir David Nicholson, former NHS boss for England, has broken silence and expressed concern that if nothing is done now about the debt for health care and left until after the election in 2020, then the NHS will suffer ‘managed decline’.
Quite what is meant by ‘managed decline’ is not specified; except that it will include longer waiting times, reduced services and freezing recruitment to vital services.
Nicholson’s concern is further compounded by the lack of clarity over future financial provision for health in the party manifestos. Some, like the Tories, have specified an increase and given some indication where the funds will come from, whereas others, like Labour, have underestimated the scale of the potential shortfall and failed to give enough assurance of how they will find the money.
The Greens have promised to bring the NHS back into public ownership but fail to appreciate the scale of the task and seem to have ignored the effect of PFI on NHS finances.
Take one hospital in London that has a 43 year PFI contract. They will pay back £7bn on a contract worth £1.1bn.
Match this against the International Monetary Fund prediction that the UK will still be in dept in 2020 and you begin to see the scale of his concern. But that concern must also be felt by any party that wants to expand and inject cash into improving health care and delivering more for less.
We will soon hear from the Pay Review Body (PRB) who is due to report on 7-day working. You may recall that the Tories, having said they would not pay the 1% increase, caved in when we took industrial action and then decided that they would ask the PRB to make recommendations on 7-day working.
Problem with this is that when we gave oral evidence to the PRB last month they were adamant that they would not make recommendations and will only publish ‘observations’. The problem for the next government/coalition - whatever - will be what to do with the ‘observations’ from the PRB.
One key element from all parties who gave evidence to the PRB is that 7-day working is not a cheap option and will entail more staff, more admin, more capital investment and more co-operation.
If Nicholson’s prediction on future NHS funding and the decline in service delivery is correct and the IMF prediction is also realised, then the future for the NHS is decidedly rocky.
One point made by Nicholson is the saviour for health care is that even in deep crisis the NHS continues to survive.
The sixty four dollar question is not if it survives, but in what form and for how long.