News / Association calls for debate on scale of NHS funding

The HFMA has called for a public debate about whether taxpayers are willing to pay more to fund the NHS and backed a mechanism to link overall NHS funding
to a proportion of GDP.

In its submission to the House of Lords’ enquiry into the future sustainability of the NHS, the association said it was the right time to have an honest debate about the appetite for higher taxes to pay for the NHS.

If not, the debate should move to deciding the level and range of universal services that should be provided by the health service.

The HFMA told the Lords committee holding the enquiry that NHS bodies were struggling to meet demand and balance their books. Though quarter one figures for 2016/17 were more positive, this was only achieved with the sustainability and transformation fund.

Without this, the underlying position was similar to that a year earlier and in the HFMA NHS financial temperature check survey, finance directors had reservations over whether estimated efficiency requirements were realistic.

HFMA policy director Paul Briddock said: ‘If demand for NHS services continues to increase, the pressure will continue to build. Even now, NHS finance staff – and other healthcare managers – find themselves with the seemingly impossible task of cutting costs while activity increases. This position is not sustainable.’

Finance directors have previously told the HFMA that additional funding, over and above that already promised, was the their preferred action to return financial sustainability while maintaining clinical service quality.

The HFMA noted the Organisation for Economic Co-operation and Development (OECD) figures, which showed UK health spending stood at 8.5% of GDP in 2013.

This included public and private spending on healthcare. UK spending was about the same level as total spending in Finland and Italy, but less than the average across the 30 OECD countries (8.9%) and France and Germany (both around 11%).

‘We believe it would be helpful for the government to commit to a fixed percentage of GDP to fund the NHS during a spending review period,’ Mr Briddock said.

‘We must be sure we are counting like with like. However, it is clear we are out of step with other countries and we think setting health spending as a proportion of GDP would be a step in the right direction.’

The HFMA also looked at workforce, calling for a review of how doctors are educated and trained and how this is funded.

Against the backdrop of high locum spending levels, some HFMA members had suggested that medical training should be loan funded. However, the value of the loan could be reduced over a number of years as the doctor spent time working for the NHS. This would avoid the situation where public funds are used to train doctors who then go on to work outside the NHS.

In October, health secretary Jeremy Hunt said he would consult on measures that would introduce a minimum period of service for NHS-trained doctors. Those who worked less than this would have to repay some of their training costs.