HFMA 2019: OBR-style centre to take long term view

06 December 2019 Steve Brown

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Jennifer Dixon (pictured), chief executive of The Health Foundation, said the NHS desperately needed to be taking a long-term view of the resources it needed. ‘This is the biggest industry in Europe,’ she said, ‘and the short-termism is absolutely astonishing – still. We don’t project forward the resources we will need for long enough.’Jennifer.Dixon l

Two years ago, the House of Lords Committee on the Long-term Sustainability of the NHS recommended an Office for Budget Responsibility-type body for health as a solution to this short-termism. But this was never picked up by the government.

‘So The Health Foundation is going to establish a centre,’ she said. Expected to be formally launched next year, this would be headed by the foundation’s director of research and economics Anita Charlesworth and will develop careful supply and demand projections starting with England and then going across the UK.

Dr Dixon gave the conference a swift run through the challenges facing the NHS, including the need for investment, social care funding, addressing the workforce crisis, improving productivity and tackling widening inequalities.

She said that against the backdrop of these ‘serious long-term issues’ the country had a ‘frothy, toxic general election with Brexit thrown in’. She suggested that the parties were offering ‘weak signals’ from which people could only surmise what might happen afterwards.

She summarised the various offers in the main parties’ manifestos, including high level healthcare funding promises of 4.3% (Labour), 3.8% (Liberal Democrats) and 3.1% (Conservatives). She compared this to the estimated 3.4% needed to maintain current standards of care and 4% to deliver improvements.

There were various other commitments on capital, nursing bursaries and social care changes with differing approaches to tackling the wider determinants of health.

Asked which of the pledges were credible, she said it would be difficult to row back from pledges on money. However she said it was unclear what would happen if the economy took a more negative turn. She also suggested that everyone now appeared to understand the central challenge played by shortages in workforce, although manifestos were short on the detail of how promised numbers would be delivered in practice.

And although she described the lack of a long-term deal for social care as ‘the political failure of our time’, she said there were signs of growing political will across the parties to address the issue. The Conservatives have set a red-line on ensuring no-one has to sell their home to pay for care and pledged to seek cross-party consensus on reform. The Liberal Democrats have made a similar commitment on cross party agreement and would support a cap on care costs. Labour has committed to free-personal care for older people and a lifetime cap on social care costs.