Most people think that the government should consider using more private companies in the NHS “when they can provide high quality services more cheaply.”
That’s according to an opinion poll recently commissioned by Tory peer Lord Ashcroft. There is in reality little disagreement between the main parties about this approach, but the polling also shows that there is still a sharp divide in public opinion over which party is most trusted on the NHS.
Labour has a lead of 18% over the Conservatives on the issue of the NHS and so are making fears for the future of the NHS under the Conservatives central to their election campaign. Ed Miliband has refused to confirm whether or not he used the word “weaponise” to describe his approach to campaigning against the Conservatives on the issue.
The coalition’s failure to convey to the public any explanation for launching a major re-organisation of the NHS (described as “Liberating the NHS” in the initial white paper) is confirmed in this market research. People assumed that it been introduced to save money or that it was more “part of a plan to privatise the NHS” than to cut bureaucracy or give more choice and control to patients.
The recently appointed Chief Executive of NHS England Stuart Stevens set out a five year plan for the NHS last autumn. It sets out the scale of the funding challenge and could provide the basis for informed debate about health funding in the General Election. Stevens warns that a combination of growing demand, a failure to make further annual efficiencies, and flat real terms funding could, by 2020-21, produce a mismatch between resources and needs of almost £30bn a year.
On the other hand, he says that if the NHS budget remains flat in real terms from 2015-16 to 2020-21 and the NHS delivers its current long run productivity gain of only 0.8% the NHS will suffer a shortfall of £21bn. This shortfall, he thinks, can be removed if efficiency gains reach 3%, but suggests that this would require upfront investment, and major reform including integration of social care and health.
Real integration of health and social care will only occur when they are funded from a single budget and the process of achieving this will require considerable decentralisation from Whitehall to the big cities, “city regions” and “combined local authorities” that could take on enhanced powers and responsibilities, including in relation to finance.
Both Labour and the Lib Dems will be offering further funding for health and social care through some targeted tax changes. Labour are proposing to use the proceeds of a “mansion tax” on properties worth over £2million. The Lib Dems are promising £8billion pa in extra funding by 2020 through measures such as restricting taxpayer subsidies to pension contributions by higher rate taxpayers. The Conservatives may be less resistant to some extra taxation if it is levied locally as a result of devolution.
There is, therefore, much potential for assistive technology and healthcare businesses to grow, but also an expectation that they will have to help provide efficiency savings.