Good, but not yet bold: how Labour could pledge to eliminate the NHS funding gap

‘Best at our boldest’ Tony Blair once said. Now would be a good time to reassert that view. The NHS will be centre stage in next year’s election. We lead in polling on which party will take best care of it – but not by a country mile.

We should consider taking full ownership of the issue and laying out a challenge which the other parties will not be able to match. And it would positon us firmly where people expect us to be. We have got the basis of a bold position, with the pledges to merge health and social care, to repeal the Tories’ Health and Social Care Act and to establish a ‘Time to Care’ fund to boost clinical staffing levels.

Good, but not yet bold.

Why not consider a central pledge: we will meet in full the funding challenge set out in Simon Stevens’ report. The NHS Chief Executive has argued, with robust evidence, that the service needs an extra £8bn by 2020 in order to meet the public’s expectations.

With Labour, a fully funded NHS.

How could we do it? The ‘Time to Care’ fund of £2.5bn extra by 2017/18 is a start, and the additional clinical staff will go a long way to meet the expected pressures. We have already set out how the £2.5bn is funded. But we should go further.

Stevens assumes annual productivity gains of 2-3% within the service. It’s a stretching target. But we can go further, by seriously getting to grips with NHS management. There are 36,000 managers, costing £3.4bn. It must be possible to strip out substantial costs here, to be transferred over to funding the front line.

Surely, we can do better than operating with 211 separate clinical commissioning groups, 160 separate acute trusts and 56 mental health trusts. Go for significant streamlining under flat management structures. The merging of health and social care services is the gateway to this.

Surely, we do not have to continue with eight separate bodies providing ‘support services’ to the NHS. One for research and one for delivery should be sufficient.

Surely, we can do better than persist with no fewer than six separate safeguarding organisations, on top of all the individual professional regulatory bodies. One over-arching safeguarding authority, with appropriate sub-sections, should suffice.

Merging health and social care administrations and flattening the current management structure could release an additional £2bn by 2020, all available for transfer to the front line.

Finally, Ed Balls has reminded us, quite rightly, that the ‘tax gap’ has grown under the Coalition and is now thought to be £34bn annually. HMRC has acknowledged that it has a £10bn ‘backlog’ in its attempts to cut out tax avoidance. So let’s apply the raft of tightening measures Ed has set out, immediately on coming into government, and let’s hypothecate the first £5bn recouped as a result to the front line NHS budget.

These measures together exceed £8bn by 2020, thus allowing for some contingency. Nothing here would get in the way of deficit reduction. The ‘fully funded NHS’ commitment is itself fully funded.

This approach has the merit of fitting neatly into Ed Miliband’s narrative about tackling what doesn’t work and what isn’t fair. It addresses structures that do not work in the interests of the community, and it tackles tax avoiders who operate against the public interest. And it puts the muscle of the state behind securing a health service fully for the 21^st century.

This would is a bold commitment – and maybe just what the doctor ordered to reinvigorate our politics over the next six months.

James Plaskitt was  the MP Warwick & Leamington from 1997-2010