Gordon Brown gives the NHS a ringing endorsement and a significant increase in funding, writes Dr Muiris Houston, Medical Correspondent
Yesterday's budget speech was a ringing endorsement for the National Health Service. Calling it the "best insurance policy in the world", the Chancellor of the Exchequer, Mr Gordon Brown, rejected all arguments to change its funding base from one of general taxation.
He ruled out private insurance, social insurance and charging patients for clinical services as alternative ways of funding the system. Instead, he called for a renewed and shared consensus of support for the NHS, saying that it "defined the character of our country".
Contrast this with the funding questions which still hang over our own health service. Despite an impressive national health strategy, with a 10-year plan for developing the beleaguered health system, the actual funding outlined for the first year in Mr McCreevy's budget fell well short of that required to give the plan the solid base it needs. And, with reports of voluntary hospitals experiencing funding difficulties - reminiscent of the bad old days of the 1980s and early 1990s - an Irish citizen listening to Mr Brown could be forgiven for thinking "if only..."
It is interesting to reflect on the events which brought the Chancellor to the position he outlined yesterday. During his first five years, he concentrated on reducing national debt. But now that the British economy has stabilised with low interest rates and modest growth, he wasn't afraid to make the kind of commitments required to invigorate the health system.
Strategically, Mr Brown's most important move has to commit his government to multi-annual funding of the NHS. He gave a clear undertaking to increase spending on health by 7.4 per cent each year for five years. Britain now spends £65 billion sterling (€106 billion) on its health service; this will rise to £105 billion in the year 2007/08. It represents a doubling of spending in real terms, according to the Chancellor. Most impressively of all, it means that, as a percentage of GDP, health spending will rise from 7.7 per cent to 9.4 per cent in five years, which certainly puts Britain in a respectable place on the world league table of national health spending. Looked at from the perspective of the average family, it means that, in five years' time, £4,060 sterling will be spent on the NHS per household.
How is the Chancellor funding such largesse? He has decided to increase National Insurance contributions by 1 per cent. This increase will be paid by both employers and employees; its effect on families with children has been ameliorated by some significant concessions on child benefit.
In addition to increasing taxation, he is freezing tax bands or thresholds rather than allowing them rise with inflation. And he is putting a modest 6p on a packet of cigarettes.
The largesse did not come without some caveats. An independent NHS auditor will produce annual reports on the health service; the details of which will focus on where the money was spent, what the taxpayer got and what tangible results are visible as a consequence. The Chancellor also hinted that there would be financial incentives for those hospitals and services which performed best.
Sound familiar? It is the kind of language which Mr McCreevy has used of late when he signalled his unhappiness with the value for money aspects of health spending in the Republic. He made it abundantly clear that, without systems to identify the outputs and outcomes being delivered by the present level of funding, "no prudent Minister for Finance can justify committing more money to health".
The difference in approach between Mr McCreevy and Mr Brown is obvious; one recognises the underfunding which has occurred and, having got the economy under control, has no hesitation in making the "grand gesture" of substantial multi-annual funding. Mr Brown is confident enough to spell out in detail the value-for-money checklists which will be introduced along with the increased funding.
Mr McCreevy, on the other hand, has adopted a somewhat school masterish approach. He is telling the Department of Health that if it does not get its house in order, there will be no lollipops at the end of the school day. The problem with such an attitude is that it is the health of the average citizen who suffers, not the mandarins in the Civil Service.
The Minister for Finance could learn a lot from the Chancellor. He should acknowledge the chronic underfunding of our health services over two decades. He should accept that, unlike industry, health outputs take a lot longer to appear and be measured. And, most of all, he should acknowledge that, as a result of our massive national financial success, the very first public service which he should be offering a multi-annual commitment to is health.
