Will extra billions cure NHS ills?

By Ray Dunne BBC News Online Health Staff

Gordon Brown's decision to significantly boost health spending marks an unmistakable watershed for the NHS.

After decades of under-investment, the health service has finally been given what it has long demanded - a secure and sustainable financial footing.

The government has got itself into a muddle over targets for health care spending

Kings Fund report

The question now is whether the many-publicised problems of the NHS will be resolved once and for all by this large injection of money.

The chancellor believes this to be the case, staking his own political career and the future prospects of the Labour Party on transforming the NHS.

Mr Brown's decision to fund the increases through general taxation - rejecting European models of social insurance, charging or private health insurance - have raised those political stakes.

Mr Brown said paying for the health service through taxation - and tax rises - was the most equitable policy.

The prime minister shares that conviction. Tony Blair was first to commit the government to substantially increasing the amount of money it spends on health.

Spending pledge

In a BBC television interview in January 2000, Mr Blair pledged to bring NHS funding up to European levels, namely to spend 8.4% of GDP on health by 2006.

Wednesday's Budget means the government will surpass this original target with spending representing 8.7% of GDP by 2005.

However, analysts have warned that even this may not be in line with average funding across the EU by that time. Some analysts believe the average spend across Europe is already close to 10%.

Others have criticised government attempts to use the GDP figure as a measure of whether it is spending enough on the NHS not least because it does not remain constant but largely because it gives no indication of how well the money is being spent.

Some of those critics have suggested that money alone is not the answer pointing to the records of the health service in Scotland, Wales and Northern Ireland where spending is as high as 9% of GDP - higher than the EU average and close to that of France, which is regarded as having the most successful health system.

Despite these relatively large health budgets, waiting lists are still a major problem and survival rates for key diseases such as cancer are no where near European levels in each of these countries.

The extra funding has had little discernible impact.

'Misguided' policy

A report published by the independent health think tank the Kings Fund last year suggested the GDP measurement policy was misguided and was akin to the government's flawed commitment in 1997 to reduce NHS waiting list numbers rather than waiting times.

Mr Brown has pledged billions more for the NHS

"The government has got itself into a muddle over targets for health care spending," the report stated. "But we have been here before. Labour's 1997 manifesto pledge card promised to reduce the number of people waiting for surgery by 100,000...this was the wrong waiting list target to set - waiting time was more important."

The Kings Fund report suggested ministers should instead use qualitative targets - such as waiting times and the number of operations - to determine how much money is needed to bring the NHS up to international standards.

That view is shared by the Conservative Party. In a document published on Monday its leader Iain Duncan Smith said: "We have to spend more on health in this country. How much more is not yet clear...We have to identify how the NHS can deliver its ideals before we can know how much it would cost."

Falling short

Nevertheless, there is no doubt that in performance terms, the health service currently falls far short of the standards achieved in other major western countries.

In Germany, for instance, there are no waiting lists. In Denmark, there is a legal limit on the length of time patients wait for treatment. In the UK, the government has aimed to reduce maximum waiting times to 15 months by March and to six months by 2005.

Wednesday's report by former NatWest chief executive Derek Wanless into the future of the NHS suggested that a maximum waiting time of just two weeks is possible by 2022 but only with a massive injection of additional cash. He wants NHS spending to increase from £68bn at present to £184bn by 2022.

But the former bank chief is adamant that the money will not solve all of the problems - it must be accompanied by reform.

Launching his report, Mr Wanless said: "Money on its own is not enough and provides no guarantee of success - it is essential that resources are efficiently and effectively used. Resources and reform must go hand in hand - both are vital. Neither will deliver without the other."

Money on its own is not enough and provides no guarantee of success

Derek Wanless

In terms of clinical success, the NHS is also lagging behind.

A recent World Health Organisation report showed UK survival rates for some cancers were in the same league as those of some of the poorest countries in Eastern Europe.

Perhaps in this instance money is the answer. Dr Richard Sullivan, head of clinical programmes at the charity Cancer Research UK, believes these low survival rates are a direct result of poor funding.

"We do not have enough specialists,' he said. "Hospitals are also using equipment that should have been retired years ago or in some cases they just didn't have it. All of these things impact on survival rates."

Dr Sullivan suggested that even with the extra cash it might take years for survival rates to match those of Europe.

"Survival rates take quite a while to come through. It will probably be another 10 years before we see any impact."

Backed by reforms?

A report by NHS chief executive Nigel Crisp in April showed money is not the answer to all of the health services problems.

It showed that productivity in the NHS, namely the number of operations carried out in hospitals across the country, had increased only marginally despite record levels of spending.

The NHS Confederation, which represents health service managers, suggests that productivity could actually fall in the years ahead.

Its chief executive Dr Gill Morgan added: "More in the NHS does not necessarily mean better. There is a tendency to try to count gains only in hard numbers, for example, numbers of patients treated, rather than real quality improvements for patients.

The Patients Association has expressed doubts about whether any of the extra money will "bring about true improvement for patients" saying previous cash injections had failed to result in noticeable improvements.

Doctors and nurses

The Kings Fund too has concerns. Its spokesman Andy Bell said: "Certainly money is at the root of the NHS's problems [but] the thing the NHS lacks is of course staff.

The government will be judged at the next general election in three or four years time

Dr George Rae, British Medical Association

"Healthcare is an incredibly labour intensive thing to do and the NHS suffers from chronic shortages of doctors nurses and practically every other type of health professional. That is undoubtedly what is at the root of long waiting times, short consultations and many of the other things that cause problems on ground level."

But he added: "Clearly putting more money in is a precondition for getting more staff."

That view is shared by the British Medical Association. Dr George Rae, of the BMA, said the experience of Scotland showed that money was not a cure for all of the problems.

"Without the extra funding I have absolutely no doubt that we would not be able to move the NHS forward but it cannot be done by money alone. The Scottish example is proof that more is needed."

However, he is in no doubt that the the public will be expecting improvement and will judge the Mr Brown, Mr Blair and the Labour Party on its ability to deliver the modern health service they promise.

"The government will be judged at the next general election in three or four years time. Pragmatically, we are talking a bit longer before we see major changes but we should start to see tangible improvements in the next three or four years."