The elephant in the room: how are we going to fund the NHS?

BJGP JonesProfessor Roger Jones is editor of the British Journal of General Practice.

Last weekend The Times published a leading article which described the financial straitjacket in which the NHS finds itself, and suggested that the additional funding required to keep the service going should be found from sources outside general taxation. I wrote a letter supporting this view, pointing out that other healthcare systems, with perfectly respectable health outcomes, some better than ours, work on a combination or some variation of co-payment and insurance mechanisms. none of which, importantly, equate to privatisation.

I described this discussion as an elephant in the room – something that no one really wants to talk about and certainly won’t talk about in the run-up to the general election. I concluded by saying that I hoped the next government has the courage and gumption to bring into the open a discussion that everyone knows needs to take place, and which must take place if we are to preserve a national health service.

Extra money is going to be needed because the NHS is going to become increasingly expensive and there is going to be ever greater competition for money among government departments. A few years ago John Appleby, the chief economist at the Kings Fund, described three funding scenarios for the NHS – tepid, cold and arctic – and these three funding futures are reflected in Simon Stevens’ Five Year Forward View. Note that none of them are “comfortable” or “balmy”. It doesn’t require much detective work to read between some of the lines of this document to discern a lack of absolute certainty of the affordability of a publicly funded health system in the future. New models of integrated care may or may not turn out to be more cost-effective, but the NHS does not have a strong record on cost containment.

In my response to the Times leader I used the phrase “Those more able to pay for healthcare simply pay more”, and I don’t think that this is a bad mantra for the future of health funding in this country. It is consistent with social justice and I understand that there is some opinion poll evidence that it would not be an unpopular direction of travel for more affluent citizens. I think we have to tread carefully around the “free at the point of need” slogan – the NHS was never free – and we certainly would not wish to introduce a system in which health care providers need to see the colour of your money before treating you. It has been often said that the decency of a society can be judged by the way that it treats its most vulnerable and needy citizens. Requiring that the more fortunate members of our society make a greater contribution to the costs of health care could help to ensure that their less fortunate fellows continue to receive the care that they need.

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Simon Stevens has a nerve… suggesting pensioners lose their annual inflation increase and lose their assets built up over lifetime of work – look in the mirror Simon. How about YOUR final salary pension????

How about YOU contribute by only taking out what you have put in over your working life?

Why isn’t anyone shining the spotlight on the devastating effect unfunded final salary and career average pensions are having on our NHS?

Many trusts are losing a third and rising of their budget, funding the shortfall in pensions.

If you want to retire Simon on two thirds of your salary, YOU should pay for it – not my children and grandchildren!

Pay our front line NHS staff much more while delivering their excellent service but ask them to save up for their own pension.


A cash-strapped NHS trust has paid a temporary manager at rates of £60,000 a month – the highest in the history of the health service.

The payment is revealed in a Telegraph investigation which shows soaring numbers of health service bureaucrats are being paid “off payroll” – despite repeated Government pledges to clamp down on the practice.

Ministers promised to act amid concerns that the schemes were helping some managers to minimise tax liabilities and hiding “excessive and indefensible” payments.

But new figures show that in just one year, the number of managers paid “off payroll” by NHS trusts has risen by almost one quarter.

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