George Freeman or Alice Thomson: whose vision for the NHS?

15 June 2016

We have two contrasting visions of the future of the NHS yesterday and today. For George Freeman speaking for Reform yesterday, the NHS future is bright, innovative and genuinely world-leading in its mix of universal access and research excellence. For Alice Thomson today (£), the system is in its “death throes” and can only be saved by a new funding system that will steadily put more money in.

Kate Laycock has written on the Reformer about George Freeman’s big idea: that the NHS can innovate in this time of financial stringency. I will write here about this conflict of visions.

For Alice Thomson, the time for NHS reform is over. The service is deteriorating and the sole cause is a lack of funds. The UK needs to copy the higher spending levels of France, Germany and the Scandinavian countries which would mean an increase in spending of around 50 per cent, from 7 per cent of GDP to 11 per cent. The increase in demand faced by the NHS makes such an increase inevitable, she says.

There are two questions. First, is it really time to write off the current programme of NHS reform, just when it stands a chance of bedding in and making a difference? As Reform has said before, NHS reform could have started earlier and gone much further. But it is happening, the Five Year Forward View is making a difference and is aimed at exactly the problem that Alice Thomson describes, which is rising demand.

Second, if we leave the NHS unchanged, will even a big increase in funding solve its problems? Tony Blair’s and Gordon Brown’s governments doubled the NHS budget in real terms. At the same time, they allowed much of that funding to be absorbed in a bigger hospital sector, rather than developing primary care and prevention. The Forward View is now trying to unpick that. A big increase in funding which diverts more money to the hospitals would, again, be only a temporary solution to the problem.

George Freeman had a different approach to the NHS funding problem. He wanted to make the NHS much more efficient, for example by moving from paper records to digital ones. He wanted to encourage innovation, such as new types of pharmaceuticals that can report when they have been ingested. He wants a much stronger life sciences sector that generates more wealth that, in turn, provides a bigger tax base from which the NHS can be funded. In this way the NHS is part of the solution to the ongoing difficulties of the public finance rather than part of the problem.

George Freeman Speech_14-6-16 (60)

There was strong support for these ideas at the Reform event. The main question from the attendees was why the ideas weren’t being pushed harder.

I do think it is far too early for Alice Thomson to jump to her conclusion.

(The HSJ report on George Freeman’s speech did get something completely wrong. It led on the idea that the Minister emphasised a stronger role for the private sector in the NHS, and wanted a “debate on how we fund healthcare” – implying more private payments. The Department of Health then issued a clarification: “The NHS will remain free at the point of use under this government.” Actually that clarification wasn’t necessary at all. Mr Freeman wanted a “debate on how we fund healthcare” in the sense that the NHS could pay less (or nothing) for innovative drugs and devices in their early stages. He didn’t say a word about charges and he emphasised twice that nothing he proposed would lead to a “privatisation” of the NHS. The subject of his speech was explicitly faster access to cheaper innovative therapies, and better patient care as a result)

Andrew Haldenby, Director, Reform



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