The Treasury’s interim review of health service funding, now becoming known as the Wanless report after its author Derek Wanless, was published in November.
It has led to substantial debate, confusion and concern, much of it about the apparently firm conclusions in what was meant to be an interim report.
People believed Wanless would consider all aspects of healthcare funding, despite the fact it was an Exchequer-led review of how to fund the National Health Service (NHS).
But as people looked beyond the rhetoric and the government departmental tussles, the tight remit for the Wanless investigation surfaced and set the tone for debate – to determine the financial and other resources required to ensure the NHS can provide a publicly funded, comprehensive, high-quality service.
No great review of or debate on the overall options for funding healthcare then.
Maybe this is not the terminal rebuff for the private medical insurance (PMI) sector it at first seemed. I hope not.
If the report is centred around how the NHS is funded to deliver healthcare, all well and good. But if it is a replacement for the national debate we need about the overall funding of healthcare we have to understand that now.
If the final report sets out, as expected, exponential growth in demand for healthcare, then the government (and future governments) will have the same choices that have failed to resolve the gap between expectation and delivery in the past: raise taxes or increase borrowing. The International Monetary Fund has already cautioned against Britain increasing public expenditure to fund increased health spending, and even when we recently had a seemingly unassailable economic outlook we didn’t have an exactly cash-rich healthcare system.
But even then, tying investment solely to public funding relies on a buoyant economy, and the test of a successful social system is how it works in the bad times, not the good.
We are woefully behind in both public and private health spending, and dealing with just one would mean we solve only part of the problem. We can only hope the final report takes note of the vital role PMI plays in total healthcare spending and revenue generation for the NHS.