News / Election debate on health must be realistic, says Ham

The political parties must face up to the financial challenges in the NHS and not make any pledges on tax and spending that limit their ability to sustain and develop health and social care, the King’s Fund said.

With the main party manifestos due to be published in early to mid-May, King’s Fund chief executive Chris Ham (right) said during the election campaign debate on the health service would be second only to the UK’s exit from the European Union. He set out five tests of the parties’ manifesto commitments, which he said they must meet to have a credible policy on health and social care.

They must first ensure funding is sustainable. He said on current spending plans, the Department of Health’s budget will rise by about £4.5bn over the spending review period (2015/16 to 2020/21) and this was a long way short of the £10bn increase claimed by the government. Without further funding growth, patients would wait longer for treatment and care would be rationed increasingly. 

Pledges to raise spending should include sufficient funds for social care, as well as meet existing commitments on mental health and primary care, he added.

A second test – on workforce – was allied to financial sustainability. Professor Ham said shortages of staff have led trusts to rely increasingly on agency staff and the cost of this was one of the reasons for the current financial pressures. There is concern over staff retention following the bruising junior doctor contract dispute, the more challenging work environments created by rising demand and the number of GPs approaching the end of their careers. Exiting the EU risks losing European healthcare staff, adding to workforce pressures. Manifestos must face up to these issues and set out credible plans to address them, he said.

Though there is a general consensus on moving care out of hospital, Professor Ham said politicians must commit to greater integration of care. However, in his third test, he insisted they must not duck the need to change hospital services, including concentrating A&E and maternity services in fewer hospitals in some areas to improve patient outcomes.

In a blog, he wrote: ‘Politicians will be colluding in the continued provision of unsafe services if they make commitments to protect local services that are unable to meet required standards – for example, because of shortages of skilled specialists and nurses.’

A fourth test for manifesto commitments lay in turning rhetoric about preventing ill-health into cross-government action to improve population health. Led by the Department, wider determinants of health and wellbeing had to be addressed, including housing, employment, air quality, exercise and diet and nutrition. 

In the final test, Professor Ham said that the manifestos must value people and communities, including the work of third sector organisations, volunteers and families and carers. 

Professor Ham said a grown-up debate on the future of health and social care was needed. He acknowledged this would be difficult at a time of pressure on the public finances and uncertainty due to the EU exit.

He added: ‘All the more important that the parties do not constrain themselves by making commitments on tax and spending that make it impossible to do what is needed to sustain and improve health and social care. 

‘The true test of the manifestos will be their willingness to confront these issues and engage the public in a grown-up conversation about the balance between public and private responsibilities in a society in which the needs of all are valued and met fairly.’