Critical state of NHS could worsen, leading economist warns

BMJ 2015; 350 doi: (Published 05 January 2015) Cite this as: BMJ 2015;350:h50
  1. Gareth Iacobucci
  1. 1The BMJ

Politicians should be wary of using the term “crisis” to describe the current state of the NHS in England because of the potential for the service to deteriorate further, a leading health economist has warned.

John Appleby, chief economist at the healthcare think tank the King’s Fund, told BBC Radio 4’s Today news programme that although the NHS was in a “critical state” because of a shortage of funding and growing demand from an ageing population, the vast majority of people were still receiving good, timely care.1 But he warned that the NHS would struggle to retain the current level of service in the future without big funding increases from whichever party formed the next government.

Appleby was asked for his thoughts after the Labour Party published a dossier attacking the government’s record on the health service and arguing that “the NHS as you know it cannot survive five more years of David Cameron.”2 When asked whether it was correct to say that the NHS was in crisis, Appleby replied, “We should be careful what words we use here . . . Clearly things could get even worse, so what word would we use next?” But he added, “I would say the NHS is in a particularly critical state. You only have to look at the headline indicators the public care about—waiting times, for example—all pointing the wrong way, as Labour has pointed out.

“We know that demand is up as there are more people living in the population [and] more older people that seem to be more ill when they turn up at A&E [accident and emergency departments] and other places. We know the money going into the NHS has been pretty flat, especially compared with previous years. We also know the capacity for being more productive in the NHS—at least in the short term—is limited.”

Appleby said that whichever party wins May’s upcoming general election would have to commit to an extra £8bn (€10.2bn; $12.3bn) a year in additional funding over the next five years if they wanted to keep the service afloat.3 NHS England’s chief executive, Simon Stevens, believes that the NHS can deliver £22bn worth of savings, towards the estimated £30bn required by the health service by 2020.

“Without that, it’s almost guaranteed that the NHS will struggle to provide the sort of service that we’ve come to expect of it in terms of waiting times and so on,” Appleby said.

Nick Clegg, the deputy prime minister and leader of the Liberal Democrats, stole a march on both Labour and the Conservatives this week by pledging to meet the £8bn NHS funding shortfall if the Liberal Democrats re-entered government after the election in May.4


Cite this as: BMJ 2015;350:h50


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