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Independents' Day

I voted Brexit for the NHS – now show us the money

Dr Kailash Chand

Let me confess. I voted for Brexit, on a single issue – the promise of £350 million a week for the NHS made by Brexiteers led by Boris Johnson. The now foreign secretary stated in an article for the Daily Telegraph: ‘Once we have settled our accounts, we will take back control of roughly £350m per week. It would be a fine thing, as many of us have pointed out, if a lot of that money went on the NHS.’

NHS England chief Simon Stevens has now articulated the views of many like me, using an image of the notorious Vote Leave battle bus, saying: ‘The NHS wasn’t on the ballot paper but it was on the Battle Bus. Vote Leave for a better funded health service – £350m a week.

‘Rather than criticising these clear Brexit funding commitments to NHS patients – promises entered into by cabinet ministers and by MPs – the public wants to see them honoured.’

Historically, the service has enjoyed rises of around 4% to cover the cost of the ageing population and new drugs. There is a £30bn gap to fill and we should be increasing the UK’s health spending by at least £10.3bn to match that of other leading European economies.

The health and social care system is a mess. Net expenditure on social care has dropped in real terms from £8.1bn in 2005/06 to £6.3bn in 2014/15, a drop of more than 20%. The Department of Health’s budget will increase by just over £4 billion in real terms between 2015/16 and 2020/21. This is not enough to maintain standards of NHS care, meet rising demand from patients and deliver the transformation in services outlined in Simon Steven’s Five Year Forward View. The pressures on the NHS will peak in 2018/19 and 2019/20, when there is almost no planned growth in real-terms funding.

If Simon Steven’s request is not heeded by the Chancellor, the intense pressures on the NHS and social care services will continue to grow. Already, two-thirds of NHS trusts (65%) and NHS foundation trusts (66%) reported deficits in 2015/16, up from 44% of NHS trusts and 51% of NHS foundation trusts in the previous financial year. The number of CCGs reporting cumulative deficits was 32 in 2015/16, up from 19 in both 2014/15 and 2013/14.

This massive funding shortfall means hospital authorities have no choice but cutting bed numbers and already a third of A&Es are set to close to cope with rising hospital deficits. Vulnerable elderly and disabled people will pay the price for a lack of new investment in social care, according to the Nuffield Trust. The government is asking GP practices to provide more services, including many involving the transfer of hospital care into the community, without the resources required to successfully deliver them. Primary care is imploding faster than people realise and patients are already bearing the brunt of the problem.

A combined financial and staffing crisis could cause ongoing chaos for years and ultimately kill off the NHS for good. It’s impossible to see how the NHS will get through the year 2018/19, when spending per person will fall. Something will have to give, whether it’s ballooning waiting lists, record deficits, or having to refuse patients new drugs.

I echo the statement of BMA chair, Dr Chaand Nagpaul: ‘The promise of extra funding for the NHS was a key issue at the ballot box during the Brexit referendum, and people rightly expect that promise to be honoured.’

‘With the budget only weeks away, bold action to deliver on this pledge, as proposed by Simon Stevens, is urgently needed and has the backing of the BMA. This is vital in order to address the current crisis in our health service, protect and improve patient care and put the NHS on a sustainable footing for the future.’

We have been squeezing the lemon for ‘efficiency savings’ for years. But it is getting to the stage where there is nothing left to squeeze.

Dr Kailash Chand is a retired GP from Tameside and is honorary vice-president of the BMA

 

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Readers' comments (25)

  • Dr Chand is correct that we do need a significant injection of cash in order to maintain a safe service in the short term, and we have been squeezing the pips for too long. Yes demand goes up and we can do more.
    However this is not the only answer and it is a fact that the NHS is completely mismanaged. So much money is wasted and there are huge numbers of people who are not contributing to productivity at all.

    We need to get back to basics. The greatest expenditure in the NHS is on staff. Management costs as a percentage have increased more than clinical costs. The NHS needs

    1) to reduce management costs
    2) to make clinical staff feel valued and empowered to do their jobs to the best of their ability and management should exist to support clinical staff not to control them.
    3) We should aim to get to a point where we do not have to contract with as many bank staff or locums and we should try and staff to excess capacity allowing for the fact that there will be maternity leave, sickness etc. It is a false economy relying on expensive contracted staff
    4) properly staffed departments will lead to less errors and complaints and therefore less indemnity payouts. A huge amount is put aside from the annual budget
    5) There are far too many processes and tick boxes and dare I say it audit for audits sake. We have become process driven and so much data is collected that is never used. When I first started s a doctor spreadsheets were not in existence and we managed without them
    6) We waste so much and we are also having to pay far too much for much of what we use. If you are practising in the NHS you should be made to buy from a central procurement agency which sources from companies and uses economies of scale for the benefit of all NHS providers
    7) We should be paying reduced rents for NHS properties which are being used by NHS providers - not market rents

    I could go on! I am an ex GP partner who is about to retire from locuming etc. We can't just keep asking for more money without dealing with these problems as well.

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  • "Let me confess. I voted for Brexit, on a single issue – the promise of £350 million a week for the NHS made by Brexiteers led by Boris Johnson."

    Oh dear........I thought it was only the ill-informed who believed this rhetoric

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  • Yes Shaba,many were taken in by the Pied Piper of Hamelin, even the great and the good. But twas always like this if one looks down the ages.

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  • Sad to say but above are right, you were deluded on this point. There never was going to be any money for the NHS.
    The blond one was clearly spouting whatever came into his head at that moment (as usual) to get the masses to support him. Really this was no more sophisticated an approach than offering sweets to kids, except worse as the sweets never even existed.

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  • Oh, dear. You really believed that nonsense. Shame on you. Why don't you apologise to our EU colleagues who will be leaving? Why don't you apologise for the racist language they have suffered? And then apologise for the crap we will all go through in the next few years. And then stop writing this column because your credibility has gone.

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  • Oh dear Kailish...you should have kept that one to yourself!

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  • David Banner

    Voting Brexit to save the NHS is like........
    Voting Communist to save the monarchy
    Voting for Xmas to save the turkeys
    Voting Lib Dem to save Brexit
    Voting Jeremy Hunt to save the NHS

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  • What an idiot!

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  • AlanAlmond

    Excuse me my venerable collegues but the majority of the population of this country voted for Brexit. It is a noticeable characteristic of those who voted with the minority to view themselves as somehow morally and intellectually superior to all those stupid fools who disagree with them. Racist, poorly educated and backward is pretty much the standard take. You were on the loosing side of the debate my friends. Get over yourselves. The country is controlled by people who dont want Brexit..very few publicly articulate a pro Brexit view point and those that do are patronised and insulted. If you feel Brexit was wrong ..fair enough, but I remind you again you are in the minority. Although a very vocal and well connected minority at that.
    ..time for me to exit Pulse comments I suspect..these kind of views aren’t generally tolerated by enlightened remoaners.

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  • AlanAlmond

    ..I voted Brexit because I believe in democracy. The EU superstate is not a democratic entity. I didn’t believe the rubbish about NHS funding but I don’t see any reason not to push for more funding in any way we can. Politicians who suggested we’d get more cash need reminding, even if they are obviously otherwise generally full of sh&t

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  • it is unfortunate that people voted for brexit to provide more funding to relieve intense social pressures.

    https://www.theguardian.com/business/2017/nov/08/us-hedge-fund-to-take-over-indebted-care-home-provider-four-seasons

    read the reasons cited.

    this was totally avoidable. yet more British health and social care infrastructure owned by the US.

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  • Thats a shame, I like the the majority who voted Brexit because we did not want to be shackled to the undemocratic corrupt warmongering morally bereft corpse that is the European Union. Most of us saw the 350M for what it was a gimmick, there were many on both sides. Theres a world outside the EU and we were part of it before. We will be part of it again.

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  • @Virtual Nobody
    'I didn't believe the rubbish about NHS funding....'
    If it was a lie then it was a lie that may have swayed many people to opt for Brexit. There is nothing wrong with holding those liars to account now, and looks like Simon Stevens is also publicly saying that the money promised should be honoured. Or indeed why trust anyone in authority ever again?
    You talk about the EU superstate but it has limited power over sovereignty anyway- another of the great lies. Perhaps you are right and people prefer the shitfest that is Boris and co.

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  • Private motives are displaced onto the public (usually by manipulating irrational fears) and then rationalized in terms of the public interest.
    ... in other words, Brexiters, you've been had.

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  • Personally I have more confidence in EU to represent my interests rather than UK Govt.

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  • Really - you believed Boris and Gove? - REALLY? I’m dumbfounded that ANYONE believed this was EVER going to happen - even at the time it was questioned by those in the Brexit camp - I despair that there are seemingly intelligent people that will believe anything written on the side of a bus!

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  • It seems to have escaped the notice of a lot of people, but the £350 for the NHS' could only become available AFTER we have formally left, and cease paying into the EU coffers. That can't happen until March 2019 at least, and if we also choose to pay a 'divorce bill' it will be a long time before the financial benefits of Brexit become available.

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  • Personally I have more confidence in EU to represent my interests rather than UK Govt.


    .....couldn't agree more!

    I would rather be governed by democratically elected politicians in Brussels, than May who was elected by nobody....not even her own party!
    And don't even get me started on Johnson, Gove, Hunt or any of the other wastes of organs that inhabit the front bench in Parliament.

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  • Argil

    I can see the point being made by Dr Chand and I think it is a correct one. As for Brexit vote, Robert Thaler (Nobel Prize and behavioral economist at the University of Chicago Booth School of Business - not me) considered it to be good example of individuals diverging from this kind of purely rational behaviour. He somewhat forecasted the outcome and said, “most voters aren’t really thinking about it in a very analytical way… The people behind the leave campaign are voting with their guts. There’s no spreadsheet. This is much like a divorce without a prenup. You’re voting to leave, and we’ll take care of all the financial details later.”
    That is, NHS spending promises were not really taken in serious consideration. As for my current personal forecast, I can just imagine more struggles in the short and medium term for the medical and nursing profession in the UK. However, markets are and shall remain interconnected. Do not be too surprised if it will be the turn of British doctors emigrating to the Old Continent for better career and training opportunities, higher morale and greater remuneration. In fact, visa restriction may apply at some stage as well as registration barriers. Access and duration of the medial and nursing training may consequently change, but it is hard to imagine a "return to the past".

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  • £350/ week was wrong.

    The latest figure from the Office of National Statistics is actually £363m (gross).

    https://visual.ons.gov.uk/the-uk-contribution-to-the-eu-budget/

    Also Dr Chand, if may make a make a teensy, if slightly obvious point, whatever cash is freed up, it will come AFTER we leave.

    Sir Simon Stevens (stepping well outside the bounds of civil service neutrality) also seemed confused about this, this week.

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