How to future-proof the NHS – copy the Bank of England

Faced with an ageing population and funding pressures, fresh thinking is needed to brace the NHS for what lies ahead. Perhaps the answer to some of the impending problems in health policy can be solved with a relatively old idea adapted from the world of monetary policy.

In 1997, Gordon Brown announced his intention to free the Bank of England from political control and give it the independence to set interest rates. Over 20 years on from New Labour’s historic decision, it might be time to do something similar for Britain’s most cherished institution – its health service.

That’s one of the recommendations of a student-led health commission that we have overseen at King’s College London. The aim was to train young people to carry out their own policy analysis and make recommendations about an institution that they have an important stake in as users of the NHS.

The commission’s report proposes establishing an independent health policy committee to put an end to the short-term planning and quick fixes. Modelled on the Bank of England’s Monetary Policy Committee (MPC), there are several challenges that this body could help overcome.

Health spending

Spending on the health service is a source of huge political contention. It has grown rapidly over time, at over 4% per year since the mid-1950s, and has ballooned as a share of total public spending from just 7.7% in 1955-56 to 18.4% in 2015-16. Rarely a week passes when we don’t hear about the spending pressures facing the NHS.

Political parties have different ideas about how much more money the health service needs. In their election manifestos last year, the Conservative party promised an extra £8 billion for the NHS over five years. Labour said it would allocate £30 billion over the next parliament, and the Liberal Democrats pledged an additional £6 billion a year for health and social care. Who, if anyone, is right?

An independent health policy committee could conduct independent analysis that takes account of demographic changes and other cost pressures to arrive at accurate estimates of the NHS’s financial needs.

Tackling long-term health challenges

The crises in healthcare are what make the headlines: the lack of hospital beds, the waits for a GP appointment, failures to provide the expected standard of care. These things matter for politicians concerned with their prospects of re-election, but they can also become the overriding focus.

The less immediate, but potentially far more consequential challenges to public health can be neglected as a result. For example, 65% of men and 58% of women in England were overweight or obese in 2014, and only 10% of boys and 7% of girls aged 11 to 18 eat the recommended five portions of fruit and vegetables a day.

Lifestyle problems such as these have the potential to place enormous pressures on the future NHS. An independent body with the goal to deliver better health outcomes and a sustainable healthcare system would, in principle, be far more able to devote time and resources to addressing them now, leading to potentially significant savings further down the line.

Bank of England: a model for the NHS? QQ7/

Not without risk

Taking the NHS out of politics is not without risk. If things go wrong what are the consequences – and for whom? The MPC is held to account by a very specific target, set by politicians. This is to maintain inflation at 2%. If inflation under or overshoots this target by more than 1%, the governor of the Bank of England must write a letter to the chancellor explaining why, and what they intend to do about it. If health policy is to be entrusted to independent experts, we must have a similar way of agreeing what they are trying to achieve and monitoring their progress towards it.

These details are clearly important to get right, but as we celebrate the 70th anniversary of the NHS this year, it is heartening that young people – who are not just users of the health service but also its future custodians – are at least proposing some bold ideas.