Our final party conference event saw Niall Dickson chair a panel made up of Stephen Dorrell, NHS Confederation Chair, Paul Johnson, director of the Institute for Fiscal Studies, Dr Tania Mathias, a former Conservative MP, Graham Jackson, co-chair of NHS Clinical Commissioners and Mike Thompson, chief executive of the ABPI.
Paul Johnson began with the arguments put forth by Securing the future: spending on the NHS has been flat in real terms, but health as a fraction of total public spending is at the highest level it’s ever been, and other public services have been cut to a greater degree. In order to keep the service going at its current level, spending will need to rise as the population increases in size, ages and as treatments become more expensive.
Spending on the NHS has been able to increase historically alongside relatively steady levels of taxation because spending on defence, housing and other areas has been cut; there are now few options left for cuts, so he said taxes will have to rise. Social care will require similar levels of spending increases, and we will need to find a way of getting people to pay additional taxes. If you’re going to increase total public spending by 1 per cent of national income, you’re going to have to increase taxes in the long run.
When asked about personal top ups or charges, he replied that it would be very politically difficult, and in any case wouldn’t raise a meaningful amount of money. He added that the evidence suggests that a mixture of educating people and sin taxes lead to the best outcomes.
Dr Tania Mathias commented that the NHS has always been a political football, but that there is enough cross-party agreement to change this. She said that the Conservative Party is not owning the narrative over the NHS, and that conservatives should position themselves to own the revolution that Brexit presents for the health sector.
Stephen Dorrell quipped that it used to be said of the Treasury that it knows the cost of everything but the value of nothing. He said that when we talk about NHS funding, we talk exclusively about cost; if we want to change the narrative, we need to learn a new language and focus on outcomes, not just spending. A sophisticated economy makes choices, and those choices are informed by the services we want to have as an advanced society.
He suggested that if you frame the discussion on the benefits that come from a rising share of a rising share of national income, that’s how you change the narrative. He warned that we should guard against making the claim that “if we do this, we’ll save money”. All the money that goes into health spending is intended to improve people’s lives, so the focus should be on outcomes, not money. He welcomed the flexibility in the consultation on the long-term plan, which won’t end of the first day of its implementation.
Mike Thompson began by reflecting that it’s clear that feast and famine doesn’t work when set against demographic changes. You need to have multi-year budgets, as in business. In business, you very rarely get a return within a year, and it’s the same with the NHS. The new money must go towards transformative change, otherwise we’ll be having the same discussions in the future as the systemic problems persist.
Graham Jackson reminded the audience that the NHS isn’t just about A&E waiting times in hospitals, which is often how we frame it. Primary care is the bedrock on which the NHS is built, and this point should be made more often. He said that the prevention agenda is crucial, not only in terms of “stopping the smokers smoking”, but in terms of educating people about the choices they make and the health outcomes.
He added that it’s vital to ensure that the NHS pound is spent as effectively as possible, which means spending it further upstream than hospitals. When given the right information, people make the right choice, and it is therefore important that the population has health literacy.