NHS on ‘unsustainable financial trajectory’, says Sajid Javid

The NHS is on “an unsustainable financial trajectory” and without reforms funding for areas such as education and infrastructure will continue to be squeezed to pay for it, the health secretary said on Tuesday.

Sajid Javid used a speech at the Royal College of Physicians in London to emphasise his credentials as a “small-state Conservative” and said a greater focus on disease prevention, personally-tailored budgets and digital technology would help to ensure healthcare remained affordable.

But he said the challenges facing the health service had changed since its inception in 1948 owing to an ageing population and a rising burden of chronic disease. This year the NHS would “spend its original 1948 budget, adjusted for inflation, once every month,” he said and pointed out the health budget was now bigger than the gross domestic product of Greece.

Health spending accounted for 27 per cent of day-to-day public service spending at the start of the century and would rise to 44 per cent by 2024, an acceleration of a trend “in which the composition of the state has shifted towards health and care over the last 70 years”, he said.

Javid said he had led six government departments, including the Treasury, and now headed “the highest spending department” as he outlined the consequences of the health budget on the rest of Whitehall.

“I’ve seen first-hand how — when healthcare takes up an ever-greater share of national income — you have to make some serious trade-offs on everything from education to infrastructure,” he said, and suggested the solution was “becoming much more efficient in what we do.”

He noted an “even greater sense of responsibility” to ensure the extra £36bn from a new health and social care levy was put to good use. This would include putting adult social care on “a sustainable footing.” The levy will be largely funded by a rise in national insurance contributions that take effect next month.

One of the centrepieces of his speech was a new right for patients to select where treatment was provided, including in the independent sector, as the government seeks to address a waiting list of more than 6mn people waiting for treatment.

Hospitals with the highest proportion of people waiting a long time for treatment or patients waiting more than two years will be offered this “right to choose” by the end of the month, he said. Those patients who are on track for an 18-month wait will be contacted with the same offer by the end of the year.

He went on to suggest that families must play a bigger role in caring for their loved ones. “Whether it’s stopping drug addiction or dealing with depression, there’s no more powerful motivating force than family.” There was “no small state without strong families”.

He promised a new drive towards personalised care “covering everything from social prescribing to support plans” with up to 4mn people benefiting by March 2024. His current target was for 200,000 people to have a personal health budget by 2024, he said.

Javid also promised a “proper long-term workforce plan” but acknowledged there would be no additional funding to deliver it.

Professor Andrew Goddard, president of the Royal College of Physicians, said change of the kind Javid was advocating required planning, particularly when it came “to the size and nature of the NHS and social care workforce”.

He added that Javid’s acknowledgment there would be no additional funding to support this brought “clarity” but would “undoubtedly make the challenge all the greater.”