24. Future funding of health services

Devon Branch

(MFD) That this meeting of RCN Congress discusses the future funding and provision of health services without a National Health Service

Debate report

Charles Conibear, from the RCN Devon Branch, asked Congress delegates to discuss the future funding and provision of health services without a National Health Service.

He outlined the development of NHS funding  and highlighted the growing differences in the way health services are funded in the four UK countries. He raised concerns about increasing competition which he said could undermine the principles of the NHS.

Phillip McCaffrey said that as the fourth richest nation in the world, it was appropriate for us to look after people when they were ill. He made a direct comparison to the health service in place in the United States and added: “I’m immensely proud of our NHS – it’s one of the best systems in the world.”

Dave Dawes urged caution in the use of the language being used.” The NHS is not being made more efficient,” he said. “It is being cut.” Anne-Marie Probert said we had “entered into a world of fragmentation and high stakes” and Ken Buckler asked: “How many patients have to suffer?” How many nurses have to be blamed?”

Every citizen in the UK should fight to protect the NHS, said RCN President Andrea Spyropoulos. “Let’s fight for the NHS,” she added.

At the end of the debate, RCN Chair of Council Kath McCourt reassured delegates that although this was a matter for discussion, Council had heard the comments and would continue to support the principle of NHS care being free at the point of delivery.

Background

The NHS in the UK is financed primarily from general taxation but with a small amount of income generated from patients via prescription charges (in England only) and from private patients. The coalition Government in England continues to state that it will ‘protect’ the funding for the NHS within the current UK Parliament. The NHS in England also continues to target efficiency savings of £20 billion by 2014/15 to meet the efficiency challenge (often referred to as the Nicholson challenge). Many independent commentators including the Nuffield Trust have predicted that similar efficiency challenges will be required well beyond 2015 and continue throughout the next UK Parliament.

In England the Government continues to promote greater competition in the provision of health services with the aim of increasing efficiency, quality and innovation. The development of a ‘market’ in the NHS continues the reforms undertaken by previous governments including the introduction of the purchaser-provider split that was created in 1990. The Any Qualified Provider (AQP) policy is included within the wider NHS reforms currently being implemented and seeks to further increase the amount of choice available to patients in the community and therefore increases the potential for further competition in the NHS and a greater role for social enterprises and private providers.

The first Mandate between the Government and the NHS Commissioning Board was published on 13 November 2012 and set out the Government’s ambitions for the health service. The Mandate reaffirmed the Government’s commitment to an NHS that remains comprehensive and universal – available to all, based on clinical need and not ability to pay.

When people are living longer into retirement and with more complex needs, there is a question over who will pay for their care; this is similar to the current debate over the provision of social care.

All countries are facing the same core challenges from rising health demand and limited resources, however each country has different approaches to planning, organising and delivering health care with differences in the role and scope of the independent sector, including not for profit and commercial organisations.

In Scotland plans to introduce joint commissioning of health and social care services may well result in pressures on the Scottish Government’s stated position of resisting an increased role for private providers, opening procurement of health care to a wider market over time. Moves are also being made to extend the provision of social care personal budgets to health care through the integration agenda.

In Northern Ireland, the Government has recently finished consulting on a number of changes to health and social care services which could potentially lead to a more localised and personalised health service and an increased role for other providers.

References and further reading

Royal College of Nursing Policy Unit (2010) The independent sector in health and social care in England in 2009 and prospects for the future London: RCN (Policy Briefing 1/2010). Available at: www.rcn.org.uk/data/assets/pdf_file/0010/296686/The_Independent_Sector_in_health_and_social_care_in_England_in_2009_and_prospects_for_the_future.pdf (accessed 15/03/13) (Web).

Royal College of Nursing Policy Unit (2010) NHS White Paper: “Equality and excellence: liberating the NHS” (England): a summary of the NHS White Paper and some key issues and questions for nurses and nursing to consider as part of the consultation London: RCN (Policy Briefing 09/2010). Available at: www.rcn.org.uk/data/assets/pdf_file/0007/330829/09.10_NHS_White_Paper.pdf (accessed 15/03/13) (Web).

Royal College of Nursing (2012) Frontline first: November 2012 update London: RCN. Available at: www.rcn.org.uk/data/assets/pdf_file/0004/486175/FF_England_briefing_Nov_2012_LO.pdf (accessed 15/03/13) (Web).