Some cancer waits and pressure on elective waiting times are caused by lack of money, MPs hear

BMJ 2014; 349 doi: (Published 13 November 2014) Cite this as: BMJ 2014;349:g6809
  1. Matthew Limb
  1. 1London

The NHS will not collapse next year but its problems will get worse because of a lack of money, health economists have told MPs.

Experts from the King’s Fund, the Health Foundation, and the Nuffield Trust have warned of growing pessimism in health and social care about the effect of funding pressure on services. They gave evidence to the Commons health select committee on Tuesday 11 November as part of its inquiry into public spending on health and social care.

John Appleby, chief economist at the King’s Fund, said that it was especially worrying that financial problems were spreading beyond those NHS organisations that had a long history of them. A recent survey had shown that over 90% of finance directors were very or fairly pessimistic about the financial state of their local health economy over the next 12 months, he said.

“On the health side it does look very bad. I don’t think it’s a cliff edge as such, but it is clearly very difficult and getting worse. The NHS won’t collapse but there are going to be lots more problems, including problems around waiting times,” said Appleby. And there were already signs of pressure on elective waiting times and some cancer waits that were “caused by, frankly, a lack of money,” he added.

MPs also heard concerns about hospitals’ overspending and the rising cost of temporary agency staff. Anita Charlesworth, chief economist at the Health Foundation, said, “It’s clear that morale and engagement of staff in the NHS [are] declining, all of which makes it harder and harder to recruit, and the activity pressures on the sector are just not tailing off.”

Nigel Edwards, chief executive of the Nuffield Trust, said that people had left NHS jobs or training programmes to effectively become “permanent” agency staff. “So there seems to be something that’s happened to the psychological contract between some NHS organisations and staff,” he said.

He added that a competitive “shadow market” had emerged in which agencies were “outbidding” each other to attract staff, including doctors. And he noted anecdotal reports of junior doctors receiving texts offering “ever increasing amounts of money for shifts in their own hospital.”

MPs were told that the NHS in England realistically needed around £2bn (€2.5bn; $3.1bn) more next year to meet its obligations. And experts voiced doubts about how much the Better Care Fund would help to relieve pressure on hospitals by pooling £5.3bn of existing NHS and local authority funding in 2015-16 for a range of integrated care schemes. Charlesworth said that assumptions of cost savings through the fund were “highly questionable,” echoing concerns in a report published earlier this week by the National Audit Office.1 2

Appleby said that the timescale for health services and local government to implement Better Care Fund plans was “ludicrously short,” adding, “There is a danger we’ll fail on this, although there’ll be some successes. It will discredit in a sense the general vision towards a more unified system around health and social care.”

Robert Jenrick, Conservative MP for Newark, asked whether it was feasible for the NHS to increase the range of charges to patients or move to an insurance based funding system. Appleby said that he could see the appeal of a hypothecated tax but that it did not tackle the political problem of how much the country should spend on the NHS.


Cite this as: BMJ 2014;349:g6809


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