They say a week is a long time in politics, but it must feel like an eon to anyone working in the NHS. The future of our national health service has barely escaped the headlines in the past week with concerns squarely focused, as ever, on the funding of the service and its ability to meet current and future demands. Despite a rescue fund worth £1.8 billion in 2016/17, and an extra £1.6 billion announced in last year’s Autumn Statement, it is clear that the NHS still has a long way to go before it is financially sustainable.
The Health Secretary himself has termed the current system ‘crazy’ and is publicly building pressure on the Prime Minister to adopt a ten-year funding deal for the NHS. It is said that this will put a stop to the ‘feast and famine’ culture which has been created in recent years and has led to the service becoming reliant on frequent and ever increasing emergency handouts. This feels like quite a U-turn on previous admissions from Mr Hunt, and is perhaps finally an acknowledgement from government that its support for the NHS hasn’t been quite as generous as it has previously tried to make out. Simon Stevens, Chief Executive of NHS England, has previously said that the service would “greatly welcome” a ten-year settlement to allow it to “plan staffing better and improve cancer and mental health care while introducing new technology”.
Behind the scenes it is said that the Health Secretary has also long been lobbying his cabinet colleagues to consider introducing a new, hypothecated, tax to fund health and social care. Granted, while it may be unusual for a senior Conservative minister to be calling for tax hikes, he has been arguing that traditional Conservative voters are now more concerned with security in old age, meaning a health and social care system that can support them, than lower taxes.
His message appears to have been received, at least in part. Mrs May has now publicly promised a multi-year funding plan for the NHS in order to provide a long term solution to the current funding crisis. However, anyone expecting an immediate resolution to this problem is likely to be disappointed. While the Prime Minister has indicated that we may not have to wait for the Spending Review next Easter, in correspondence with Mr Stevens it has been agreed that he will deliver his priorities for the service by the summer, meaning we are unlikely to see any real change before then. In addition, the introduction of a new tax, if it is to happen, will have to wait until the Budget which is still six months away. Mrs May has said that during this time she intends to build a political consensus on improving productivity and efficiency, and reducing cost pressures. However, with an open letter from nearly 100 MPs calling for a cross party parliamentary commission on the issue published last week, to many this will seem like an unnecessary step.
The Prime Minister also still needs to answer the big questions, such as how much funding will be allocated, over what time period and, crucially, how will it be paid for? For this, she is expected to consult with professional organisations and members of the clinical community, however the phrase ‘how long is a piece of string’ immediately springs to mind. In addition, she must exercise trust and discipline, and avoid introducing unnecessary accountability measures which have too often served to stifle transformation rather than encourage it. The NHS has long complained that its ability to truly revolutionise services is inhibited by the need to balance its books strictly on an annual basis. If this latest proposal is to truly revolutionise the prospects of the NHS then it must be a genuinely long-term approach in both spirit and nature.
It’s clear as well that there is a role for the local NHS to play here too. A quick glance at NHS England’s ‘Funding and Resource 2018/19’ document, serves to emphasise how little of the NHS’ budget is spent centrally. Instead, the vast majority is handed directly to Clinical Commissioning Groups (CCGs), who will receive a total of £75.6 billion in the upcoming financial year. If and when more funding does become available, these organisations will be required to move away from ‘survival mode’ and towards a focus on transforming and improving patient services in the long term, whilst continuing to deliver on NHS England’s plans to transition to greater integrated care. This task should not be overestimated however, and local NHS chiefs can be forgiven for being reluctant to invest to truly transform services following a near decade of austerity. While the immediate priority is likely to remain ensuring the sustainability of existing services, many areas of the NHS are crying out for extra investment.
However, Ms May’s promise doesn’t take away from the very real crisis that the NHS current faces. In a report published last week, the Public Accounts Committee stated that the NHS’ financial situation remains perilous and on Monday the British Medical Association claimed its latest forecast predicted winter pressures lasting up until the summer. While the Government may point to the extra £2.8 billion the NHS was handed in the autumn budget the truth is, that doesn’t even touch the sides. NHS trusts forecast a deficit of over £900m in 2017/18 and increasing demands mean it will barely cover the gap.
Don’t expect to see an end to the feast and famine culture quite yet.