ABHI Update: Prime Minister Announces NHS Long-Term Funding Plan
The Prime Minister has moved ahead of July’s anniversary to announce increased, long-term funding for the NHS. It would be wrong not to welcome any such commitment, and we have done so. It should be noted however, that an average increase of 3.4% is at the very bottom end of what many commentators estimated was needed simply to carry on as we are, is below the historical growth of 3.7% enjoyed by the service, and is some way below the 4% that most agree would be needed to see demonstrable improvements. It is also slightly front loaded with larger increases in the first two years.
There is also the issue that the settlement does not include any element of either public health or social care, both inextricably linked to the performance of the NHS. For that we will have to wait for next year’s Spending Review and the much delayed Green Paper on Social Care which will lay out the government’s vision for that sector.
Criticism has been levelled from all sides about how the increases will be paid for. The Prime Minister cited a “Brexit dividend,” which will probably not exist, leaving only increased taxation or borrowing as a way to deliver. Both of these are the antithesis of traditional Tory policy. We will all await the autumn Budget with heightened interest.
Along with the funding will come a new 10-year plan, building on the Five Year Forward View of 2014. The PM has said her priorities will be putting the patient at the heart of the service, an engaged workforce, harnessing the power of innovation, focussing on prevention, not just cures and parity between mental and physical health. In her speech at the Royal Free yesterday, the PM cited a number of health technologies, including AI for the diagnosis of cancer, remote monitoring of cardiac patients and glucose monitoring.
The main operational priorities will remain urgent and emergency care, maternity and mental health, which along with cancer, is top of the PM’s personal wish list. In short, we have a non-elective problem, and, unchecked, current levels of demand will require us to have twice the hospital capacity in ten years than we have today.
Simon Stevens has been asked to produce the plan by the autumn, which may pose challenges for the original intent. Whilst, building on the Five Year Forward View, NHS England could probably write a ten-year plan tomorrow, indeed they probably already have, obtaining full and meaningful consultation with the public, as promised by the PM in March, cannot be achieved in this timeframe. There was also no mention of the “NHS Assembly” which was expected to deliver the plan.
Of particular interest was the fact that the PM explicitly said that legislation would be changed if it got in the way of the integration required. Most commentators, including your author, had presumed that no legislative time would be available for the foreseeable future. It would be wonderfully ironic, would it not, if the end of the experiment in market based reforms for the NHS was heralded by a Conservative administration?
As I postulated last time, Members will see some easing of the pressures on the acute sector, although this is likely to manifest itself in an increase in elective activity rather than any loss of focus on costs. Elimination of variation in all things, including acquisition costs, will be a key theme of the coming months and years.
Whilst welcome, the increases are far from the riches seen from 2000, and 3.4% may not be enough to even keep pace with the demographic pressure on the service. The absolute focus, and the opportunity for Members, will be around delivering care in new settings and preventing delayed transfers of care. The story of how technologies can deliver against these, is the one most likely to fall on receptive ears. It also looks ever more likely that the woes in social care will need to be tackled by capability and capacity provided by the acute sector, if beds are, indeed, to be unblocked.
Personally, I am a little surprised that the announcement has come now rather than on the NHS’s birthday in two weeks’ time. It may betray the complex and unstable political environment the PM finds herself in. The prospect of defeat on amendments on Bills in the Commons in coming days and weeks looms large, and there is the small matter of next week’s European Council. All this could quite conceivably and very easily derail the ambition laid out over the last couple of days. The future is very much uncertain and, as I pointed out last time, a government can make as many commitments as long into the future as it likes, but it can only control things in the current Parliament. This spending settlement runs through until 2024, but there will be a General Election in 2022 at the very latest. A new government will bring new priorities and new commitments and, who knows, maybe that magical 4%!
We will continue to keep our Members appraised.