From Feast to Famine: Reforming the NHS for an age of austerity

Over the past two years the SMF Health project has examined the future of the NHS in the coming decade, in the face of demographic, technological and now economic change. In the context of a crisis in public finances the final report looks again at the sustainability of tax funding, and asks how an equitable health system can be safeguarded in the years ahead. The report examines whether new measures should be taken to manage demand for health services to relieve pressure on the NHS. The Social Market Foundation (SMF) is sponsored by Bupa and Standard Life Healthcare.

Having enjoyed massive increases in funding the NHS now faces the need to adjust to the lean times ahead. There are major savings to be made, but high quality local commissioners must drive them, with central government taking far less responsibility for health services. This will mean a political shift away from the idea of a uniform National Health Service towards an acceptance of locally varied, diverse provision. Only through empowering locally accountable commissioners and managing demand can the health service survive the challenge of the next decade.

 Key recommendations include:

  • The principle of universal free access by all must remain
  • The NHS should remain funded by taxation
  • New private payments should not be introduced to raise revenue
  • The next decade will see a thriving market in insurance-based products that supplement NHS care by paying for top-up drugs
  • Existing PMU products should offer an alternative to the NHS
  • GP led health centres should become holistic wellness centres
  • There should be new charges capped at £100 for GP consultations.


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From Feast to Famine: Reforming the NHS for an age of austerity
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