This is how I would solve the NHS crisis

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This article was originally published in the Independent on the 15th January 2018.

During the weekend, three nurses who had collectively served the NHS for over 40 years came to see me at my constituency surgery in Streatham. They spelt out in technicolour how serious the ongoing NHS crisis is.  

One told me that, given the nursing shortages, they were assigned eight elderly patients suffering from dementia with multiple medical needs on a ward in one of our local hospitals. Over a two-hour period, this nurse would have to administer various medications to his patients, often intravenously, spending a total of 15 minutes with each patient if he was to complete his round in time. He could just about ensure all patients had their medication in that timeframe. But if, say, they needed washing (many were incontinent) he was faced with a choice of ensuring they all had their medication in time or tending to those who needed help washing when necessary – an impossible situation.

As a local MP, I have regular catch-ups with the chairs of our local hospitals. One, Lord Bob Kerslake of King’s College Hospital Trust, a former head of the Civil Service, resigned just before Christmas. He did so in protest at underfunding.  

King’s, which is one of the country’s busiest hospitals, has had severe financial problems not least because of rising demand and the increasing cost of medical supplies, yet it is having to tighten spending. In spite of this, the staff there do an incredible job. It has an international reputation in several areas, including neuroscience, and, as a major trauma centre, was involved in treating the victims of the Westminster and London Bridge terror attacks.

King’s isn’t an isolated case – other hospitals are struggling under the strain too. For example, Guys and St Thomas’ NHS Foundation Trust – the local hospital I was born in – has reported ambulance delays outside A&E of between 30 and 60 minutes for almost 20 per cent of ambulance arrivals these last few months. And, nationally, on the basis of the most recent quarterly figures, over half a million patients were waiting for more than four hours in A&E to be admitted, discharged or treated – an increase of nearly 600 per cent compared to the same period in 2010.

Undoubtedly, the policy decisions of Conservative ministers since they came to government in 2010 have helped foment this crisis. Their top-down reorganisation – something they promised never to do – alongside their infamous Health and Social Care Act was a lesson in how not to govern.  

Nevertheless, whoever is in office, crisis or no crisis, as a country we face some big decisions if we are to ensure the sustainability of the NHS in a changing world. In short, we are asking the NHS to do very different things compared to when it was founded 70 years ago, but we are not making the radical changes in funding that will be required.

As the nurses who visited this week told me, an ageing population is putting huge extra demand on the system, with people living longer who have multiple needs. Medical advances mean that there is actually more the NHS could do, but we do not have infinite resources – so what do we want the NHS to do and not to do? It simply can’t do everything.

There is growing obesity, poor air quality and myriad other issues in our society, which mean people increasingly are seeking treatment in a way they did not before. The solutions to these problems will span governments of different persuasions, which is why I and 90 other MPs from different parties have called on the Prime Minister to set up a cross-party convention to look at the future of health and social care in England and come up with a plan. We have ducked these challenges partly for party political reasons – but the NHS is too important for this to continue.

The independent Office for Budget Responsibility has carried out analysis of what it thinks future demand will be on the NHS and what the future funding requirements will be. Their projection is that NHS spending could rise at around 4.5 per cent a year in real terms driven by societal and other changes. If we were to increase funding at this rate, it would entail spending by over £30bn more on the NHS by 2022-23 than we do currently, simply to maintain current standards of care and meet the rising demand.  

In advance of the 2017 general election, the Nuffield Trust assessed the manifestos of the three main national parties. One of the reasons I am Labour is because the 1945 Labour government, led by Clement Attlee, founded the NHS, one of our greatest achievements. However, although we pledged to spend more on the system than either the Tories or the Liberal Democrats, all of our offerings were found not to keep pace with projected growth, demand and cost increases.  

Of course we need better integration of physical, mental and social care in Britain, better take-up of new technologies and prevention programmes ensuring people lead healthier lives, and the NHS must be more efficient. But we cannot ignore the basic fact that the NHS needs substantially more money.  

For too long we have propagated the myth in the UK that we can have Scandinavian-style public services with American levels of taxation, and now that myth has been exposed as a lie. Increasing corporation tax, making the super-rich pay more and clamping down on tax avoidance are all necessary but will not plug the hole. In the end, we are going to have to contribute more if we want the NHS to continue doing what we expect of it.

I think most people would be prepared to pay more to fund the NHS, which is why for some time I have favoured a form of hypothecated taxation (or an increase in national insurance) specifically to fund the NHS.

Traditionally the Treasury has opposed it for various reasons and it is not without its challenges. But even the former permanent secretary of the Treasury, Sir Nicholas Macpherson, appears to have come round to this view, tweeting earlier this month that we need “a grown-up debate on long term funding of the NHS” and suggesting “a hypothecated tax to be renewed every five years”.  It need not be the only revenue stream for the NHS – if it were, the danger is the service would receive less revenue in a recession and more at times of growth – but it would certainly help bring the public round to paying more tax for something they treasure.

All of us have our own story to tell about how the NHS has affected our families. My Westminster office overlooks the maternity unit at St Thomas’s where I was born. Due to complications when my mother was pregnant with me, I was born several weeks prematurely. Had it not been for the care we received, neither my mother nor I would have survived.  

Unless we stop sticking our heads in the sand and confront these issues on how we sustain the NHS, the risk is it will not be able to continue saving lives as it does every day.

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