In 2010, the Commons health select committee warned the new Conservative-led government that the NHS in England was facing cuts rather than the promised real-terms increases. The message could not be easily dismissed, as the committee was then chaired by a former Tory cabinet minister. Now, eight health secretaries later, plus ça change, plus c’est la même chose. The Institute for Fiscal Studies said this week that day-to-day NHS spending had grown by 2.7% a year during the current parliament, well short of the 3.3% annual increases pledged by Boris Johnson in 2019.
The Tories claimed at the last election to be the party of the NHS, seeking to capitalise on Brexit’s unfounded claim to be good for the health service. Voters don’t buy that today. Long waiting lists at hospitals for elective operations and frustration over the lack of access to GPs have led to public satisfaction with the health service plummeting to an all-time low. An estimated 250 patients are dying unnecessarily every week in England because of the queues for emergency care. Both the government and NHS England blame industrial action for waiting lists not falling fast enough. But, as the Nuffield Trust health thinktank pointed out last year, it is “unlikely that the lost activity would have been enough to enable waiting lists to come down”.
It is true that the pandemic and cost of living shock have not made life easy for ministers. But there has been resistance in Conservative ranks to viewing the NHS as a national investment that improves societal wellbeing, protects people from the financial consequences of illness, reduces health inequalities and supports economic growth. Rather, it is seen by many Tories as a drain on the public purse.
From 2010/11 to 2019/20, the average funding increase for the health service was less than 2%, which led to a shortfall of about £30bn in its annual budget, compared with what would have been expected if the NHS had received the historical rate of spending that allowed it to keep pace with long-term pressures from demography, medical advances and rising patient expectations. The result was that the number of patients who had been referred to hospital but were still waiting for treatment doubled from 2.3m in January 2010 to 4.6m in December 2019.
Covid-19 only made things worse – the overall waiting list for routine treatments stood at 7.54m in February. Sufficient funding has not materialised to deal with the backlog. Demand for private healthcare has soared, leading to concerns of a two-tier system. Sir Keir Starmer says his party will get the health service “back on its feet”. This may be costly. Labour has signed up to the government’s NHS workforce plan, which implies annual budget increases of 3.6% a year in real terms. In Sir Keir’s defence, he might say that this is a long-term ambition. However, the Labour leader might not want to leave it too long. A winter flu crisis and rising public anger forced Tony Blair’s hand over NHS spending in 2000. Surely it would be better for Sir Keir to be ahead of the curve than behind it.