Will Brexit fix the NHS funding issue?
Some sunny weather and all sorts of celebrations for the Queen's birthday seem to have galvanised 'grass-roots' referendum campaigners on both sides of the argument at the weekend. It was hard to see, before the campaign kicked off in earnest, how the NHS would feature on either side of the Brexit debate. In the current climate though, it was inevitably likely to be about the money.
Big claims have been made for the amount of money we would save if we left the EU and the extent to which some or all of that could be spent on the NHS. Sarah Wollaston MP referred last week to the Leave campaign having 'hi-jacked' the NHS logo for its battle bus. She also said she had taken issue more than once with Leave campaigners' facts and figures. The mystical £354m a week which might be 'available' for the NHS feels a bit like my son's birthday money – it's already been spent several times over in anticipation, and it's not anywhere near the projected amount he hoped for.
The idea that we could free up really significant sums of additional finance for the NHS, and that this alone would justify an exit from Europe begs some rather different questions though. Stephen Dorrell has commented recently on an urgency over both the quantum and structure of funding for health and social care. The money is certainly very tight but it's even tighter in local government and social care, and that is having an inevitable impact on delayed transfers of care which affects the NHS.
NHS, social care and other local government organisations are working very hard across the country to find ways to deliver more for less, whilst still maintaining quality, through many new models of care. If a Brexit 'bonus' meant that we really had lots more money to throw at the system, would that result in improvement and efficiency on a scale that we are going to need in the future as demand on the health service grows, prompted by a whole range of factors, of which EU migration does not seem to be anywhere near the most significant?
Part of the Holy Grail in the searching for cost effective new models, is patient centred care. The lady who thrust a leaflet at me about Brexit on Saturday prompted me to think more about the issue of NHS funding and the notion that we could just keep increasing the money. Carol Sikora has written recently in the Sunday Times about the reality for patients in cancer care. I have some recent experience in this area and Dr Sikora's article struck a chord. If care is structured as he describes, it is that way for a reason. If care does not feel very patient centred, in the context of agreeing a clear plan, setting patient expectations, having enough time with clinicians to explore options and understand impacts, it must be that part of the reason is to get maximum outcomes within the funding available. That might not translate to infinitely individualised care. Should we not now recognise that?
I have some experience of clinical delivery. As I thought about what I would consider really good care in this context, care that reduced anxiety and supported me and my family, care that did not require me to do all the research online into options and variations so that I could ask the right questions rather than merely being told what would happen next, I realised that it would almost certainly be a lot more expensive that it seems we can presently afford. That must apply across the board to many services.
Before NHS funding is relied on as a justification for exit we need to ask what kind of service we can afford and decide whether that will meet the majority of needs and how we can support the system to get the very best from what it has. Judging by past experience, just throwing more money, weekly sums that a 'stay' campaigner described on Saturday as 'unimaginable', whether it is £354m or £160m or another number, is probably not the answer on its own.