A Labour government could boost the NHS by committing a specified proportion of national wealth to fund it and setting up a new independent body to ensure ministers give it the money it needs, the shadow health secretary has said.
Jonathan Ashworth said a watchdog modelled on the Office for Budget Responsibility (OBR) would help ensure the NHS received proper funding and avoid rows like the one over Theresa May’s claim that her administration is giving the NHS more money than it asked for.
Labour is looking into the practicality of having a new fiscal rule that would guarantee the health service a minimum proportion of government spending, modelled on the existing processes that allocate specified percentages for defence and overseas aid.
If that existed, a Jeremy Corbyn-led administration might decide to try to get British health spending back up to the European average as a share of gross domestic product, as Tony Blair’s Labour government did in the 2000s.
“I’m attracted to the idea of having an OBR-type body which assesses NHS finances, maybe at the start and middle of the parliament, [and] assesses the state of the NHS,” Ashworth said in an interview. “I’m attracted to the idea of an independent body, because we’ve seen in recent weeks the political arguments over the £10bn [that May claims her government is giving to the NHS in England]. An independent body would give certainty and an extra level of scrutiny.”
An authoritative independent body would both help ministers decide how much money the NHS needed to cope with rising demand caused by an ageing population and check on the government’s progress towards delivering those amounts, Ashworth said.
This month he told a House of Lords inquiry into the sustainability of the NHS that he favoured the creation of a watchdog that “gives periodic reports on the financial pressures on the NHS, what is needed and what are the workforce pressures, and offers a degree of objectivity in the planning which is sightly separate from the political knockabout that inevitably happens in the House of Commons.”
Other opposition parties also support the creation of a body to monitor government spending on the NHS. Norman Lamb, the Liberal Democrats’ health spokesman, has said he favours “an independent periodic assessment of how much you need to raise to spend on achieving an effective and efficient health and care system”.
Lamb told the Lords inquiry: “In an age when trust in politics and politicians is at an all-time low, creating an independent process that gives people some sense of reassurance about the amount that we need to spend makes it much easier to make the care for increasing the amount people have to pay, if necessary, to fund the system.”
Philippa Whitford, the SNP health spokeswoman, also backs creating a new watchdog but believes the OBR’s remit is too limited, given that the National Audit Office issue regular updates on NHS finances. “What you require is an arm’s length body that is part of the decision making so that it does not become nailed down into the five-year [parliamentary] cycles,” she said.
Leading health thinktanks have thrown their weight behind the calls for an OBR-style body, which the Lords select committee is considering recommending in its final report due in March. But critics say the NHS already has too many bodies with overlapping responsibilities.
Prof Anita Charlesworth, chief economist at the Health Foundation, said: “New bodies such as the infrastructure commission have been put in place to improve decision making, transparency and accountability. There is a strong case for a similar independent body in health – an OBR for the NHS. A new independent body to ensure the the NHS is not just delivering high-quality care today but has the resources (money and people) it needs to meet the challenges of the future.”
Prof Chris Ham, chief executive of the King’s Fund, said: “The NHS has gone through cycles of boom and bust and we would welcome plans to create greater certainty on future funding. We would also welcome regular independent assessments of funding needs, [but] these assessments should include social care as well as the NHS.”
But Prof John Appleby, chief economist at the Nuffield Trust, said a new fiscal rule could mean the NHS ends up getting less money than it needs.
“Fixing a minimum target spend for the NHS may have its political attractions but makes less sense in economic terms,” he said. “In practical terms, too, it is not clear what such a minimum should be or on what basis it would be chosen.”
Charlesworth agreed, saying: “Fixing health spending as a share of GDP would be an improvement on the funding outlook for this decade, but it is unlikely to be enough to match demand pressures on the health system in the long term.”
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