How much should we spend on the NHS?

The BMJ asks: after 70 years, how much should we be spending on the NHS – and how will we pay for it?

With the NHS celebrating its 70th birthday this year, the medical community and public at large is discussing the fact that the organisation needs more funding. But the BMJ asks: what is the ‘right’ amount to spend, and which models of funding are best?

The debate has gone on throughout the entire lifespan of the National Health Service, according to Anita Charlesworth, director of research and economics at The Health Foundation, and Professor Karen Bloor from University of York.

Currently, the UK spends around 10% of its GDP on health, which is approximately the same as other European countries and double the proportion of spending when the NHS was founded in 1948.

However, in terms of tangible resources, the UK compares poorly; we have below average numbers of doctors, nurses, hospital beds, MRIs and CT scanners per head than much of Europe.

Metrics to determine the ‘right’ amount of funding would focus better on inputs, processes, and outcomes of the NHS experience.

By any measure, over 70 years the NHS has succeeded in the core objectives at its creation: financial protection and equity of access to care, Charlesworth and Bloor say.

Some of the current pressures on the NHS and other systems around the world “are a product of the success of healthcare,” they add, while Brexit “is likely to cause further resource constraints, particularly in terms of staff.”

NHS expenditure is essentially a political choice, they write, but, regardless of political trends or economic circumstances, general support for the founding principles of the NHS remains high.

After eight years of historically low funding growth for the NHS, coupled with ongoing demand pressures, “the NHS is finding it increasingly difficult to maintain performance on several high profile targets,” say Mark Hellowell at the University of Edinburgh, John Appleby, Chief Economist at the Nuffield Trust,and Mark Taylor at the National Institute for Health Research.

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The three argue that the immediate prospects on funding “do not look good” and ask whether existing sources (i.e. general taxation) will be sufficient.

They discuss the principles of fair funding – from increasing user charges to creating a specific NHS tax – but say “it is hard to see that the benefits claimed for such changes outweigh the costs of moving away from the current source of general taxation.”

The 10-fold increase in funding since 1948 has largely been financed from changes in government spending priorities – notably greatly-reduced spending on defence, housing and what were previously nationalised industries. Now, there is much less room for this sort of reallocation.

They argue that other areas of public service, “have already been cut to the bone and extra money will inevitably have to come from new, or higher, taxes.” They conclude that, more than ever before, “higher taxes are an inevitable consequence of a desire to spend more. The choice, as they say, is ours.”

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