In Depth

Five unanswered questions about Theresa May’s NHS funding pledge

Move to increase healthcare spending in 70th birthday year of NHS welcomed - but issues remain

Theresa May has signalled that the Government will back the first ever long-term funding plan for the NHS.

In what BBC health editor Hugh Pym describes as a “radical move”, the Prime Minister said she wanted a “long term” and “multiyear” approach to funding the NHS, rather than the current yearly top-ups.

“Ensuring the NHS can cope with demand ahead of the spending review, I would suggest we can’t wait until next Easter. I think in this 70th anniversary year of the NHS’s foundation, we need an answer on this,” May told the Commons Liaison Committee.

Her lack of a soundbite “meant some didn’t immediately see how huge a political moment this was”, says HuffPost’s Paul Waugh.

But “the swift response from NHS chief Simon Stevens was telling”, Waugh adds. Stevens said May’s words were “very welcome, timely and significant”.

The funding change is also a “significant victory” for Health and Social Care Secretary Jeremy Hunt, says The Spectator’s Isabel Hardman. “That he has secured extra money for the health service and a promise of a long-term settlement shows how good an operator he is.”

But despite the cautious praise, there are still key unanswered questions about the plan.

How much extra funding will be available?

May “did not mention how much more money the long-term plan could involve”, says The Guardian. But the Office of Budget Responsibility has calculated that getting back to the rises that the NHS received from its creation back in 1948 up until 2010 - with average annual increases of almost 4% - would need the NHS budget to jump to about £150bn by 2022-23.

That is “£20bn more than currently planned and a huge increase on the £125bn that has gone into health in England this year”, says the newspaper.

According to independent charity The Health Foundation, the “level of funding growth the NHS and care system need cannot be found within current government spending plans”.

When it will arrive?

May made no mention of a specific date, but “her reference to the NHS’s 70th anniversary, which is in July, suggests a political imperative for an announcement on funding to be made by the summer, which would then be confirmed in the autumn budget”, says The Daily Telegraph.

The new money “will kick in from next spring, as Britain leaves the European Union, allowing ministers to argue that the Government has begun to fulfil the pledge of Vote Leave that £350m a week should be diverted to the NHS”, according to The Sunday Times.

Will it include social care?

Historically, the burden of social care in England has fallen on local authorities, which are required to offer support to those who meet national minimum eligibility requirements.

Last week, Hunt announced a Green Paper to look at the future of social care funding. This report would set out to “jump-start debate on where future social care funding should come from - though any solution would be premised on the idea of shared responsibility for care between the state and the individual, albeit with the latter’s liability for costs limited by a cap”, The Guardian reports.

Influential backbench Tory MP Sarah Wollaston welcomed the move, but said that if social care were to remain separate from the NHS, it would be a huge challenge to reach agreement on funding sources and allocation.

How will the extra funds be raised?

Professor Anita Charlesworth, director of economics and research at The Health Foundation, says taxes would have to rise to pay for the increasing health funding, reports The Guardian.

“All independent analysis suggests that the NHS and care system need increases of about 4% a year above inflation,” said Charlesworth. “Funding increases at that level can’t be found from within the Government’s current spending envelope and would be a big increase in borrowing, so must mean that taxes are going to have to rise.”

According to a cabinet source quoted by The Sunday Times, “a special NHS tax is still on the table”.

With the public “sceptical about the ability of politicians to act in their interest” but increasingly accepting of the need for more taxation to fund public services, “politicians are keen to link revenues to specific items as a way to increase spending transparency and make tax increases more palatable”, adds the Financial Times.

Why now, after years of warnings about health funding?

The plans have been developed amid “a growing realisation in Cabinet that health has become the Tories’ Achilles heel”, says The Sunday Times. The newspaper reports that current casualty waiting times are the worst on record, and more than four million people are on waiting lists for treatment. In the last three months of 2017, more than 22,000 scheduled operations were cancelled, leading to claims that the health service was unable to cope with demand.

The Tories “have been wounded by criticism of their handling of health spending and recognise that it will be Labour’s main line of attack at the next general election if the problem is not fixed”, adds The Daily Telegraph.

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