How can the NHS be funded?

With an election looming, conversations about the NHS will intensify. Some people would like to ask fundamental questions about the funding model of the NHS, and whether or not it should no longer be funded by general taxation. The proposed arguments tend to paint a picture of irreversible decline in the NHS, of an unaffordable service, of a health system out of kilter with better ones around the world.

None of those criticisms is necessarily valid. The decline in the NHS is a relatively recent phenomenon, triggered by a decade and more of political austerity measures, which deprived the NHS of funding and eroded baseline population health. How much we spend on the NHS – and social care – is again a political choice.

When I recently discussed the state of the NHS with a Brazilian public health expert, I was reminded that the NHS was the model for many health systems around the world and continues to be influential. To the rest of the world, the NHS is a pragmatic experiment – albeit not in the scientific sense ¹ – that they can learn from.

All of this before we ask the patients and staff. In unwelcome news for the ideologues, commentators, and profiteers seeking to hasten its demise, the NHS still matters. The two winning entries from the Doctors for the NHS essay competition, both published in this month’s issue of JRSM, reaffirm the importance of the NHS and support its founding ambitions of providing care free at the point of delivery and reducing inequalities.^2,3

Even if we affirm the founding principles of the NHS, the question of funding remains. Hareth Al-Janabi and colleagues argue that however you look at it, and there are three possible approaches to take when considering NHS funding – economic, benchmarking, and political – the NHS is underfunded. ⁴ The way forward is a blended approach that acknowledges these three approaches, and incorporates value judgements and empirical evidence.

Perhaps appropriately for an issue dominated by discussion on the essence of the NHS, a national database study from Wales, the home of Aneurin Bevan, the politician who led the founding of the NHS, finds that schools may be more vulnerable than households “in the event of new, more transmissible variants” of COVID-19. ⁵