Winter always puts extra pressure on the NHS so the timing of the political upheaval and economic uncertainty couldn't have been more challenging for the health service. Leaders across the service can be forgiven for feeling exasperated at the ensuing paralysis: just when we needed clear government focus working with the NHS to tackle the longstanding challenges of staffing, spiralling demand, social care and outdated buildings, attention was elsewhere.
With another big economic announcement a couple of weeks away, the spectre of "difficult decisions" continues to loom large over the NHS. Trusts are acutely aware of the importance of deploying public funding with care and consideration, tackling waste and ensuring value for money while delivering high-quality care to patients, day in and day out. But given the mounting pressures on NHS finances, warnings of further "efficiencies" are causing real concern among trust leaders and their ability to deliver care.
So it was encouraging to read Tim Shipman's piece in The Sunday Times suggesting the prime minister and chancellor are set to spare the NHS budget from swingeing budget cuts. Let's hope this is the case when the fiscal statement is unveiled on 17 November.
The NHS budget is already under significant pressure following government's decision not to fully fund this year's NHS pay awards and the withdrawal of support for COVID-19 costs.
Interim Chief Executive
The alternative doesn't bear thinking about. The NHS budget is already under significant pressure following government's decision not to fully fund this year's NHS pay awards and the withdrawal of support for COVID-19 costs. Throw inflation into the mix and this has created a big hole in national health budgets, slowing investment in technology and diagnostics at a critical time.
NHS efficiency targets are also already at record-breaking levels. The NHS was working on an agreed assumption that inflation would only be roughly 2% in coming years, and had been tasked to find a staggering £12bn of efficiency savings over the spending review period. However, inflation is spiralling far beyond those assumptions and is expected to wipe out at least £7bn from next year's NHS budget, given the rise in energy and increases in staff pay and other related costs. There are no further savings to find.
Indeed, the government needs to understand the very real impact on patient care if it doesn't plug the hole left by soaring inflation. The NHS could soon be forced to cut the level of frontline services provided to the public alongside reductions in investment across primary care, mental health and cancer services in 2023-24. A £1bn reduction in funding for frontline services could mean 700,000 fewer planned operations and procedures for patients next year. Trusts may be faced with impossible considerations such as limiting service provision in smaller paediatric units or emergency departments given the relatively higher costs incurred compared to larger hospitals. Or they might need to limit vital healthcare transformation, for example in maternity services or to bolster long COVID care. This feels like lose-lose-lose for patients, the NHS and government.
Transformation and modernisation are the watchwords for what needs to happen in our health and social care system, but to deliver this we need 21st century buildings, more beds in the right places, more care in the community and the ability to organise care in a way that better meets the needs of patients rather than organisations.
The government cannot ask the NHS to raid capital budgets to fund essential day-to-day spending.
Interim Chief Executive
The government cannot ask the NHS to raid capital budgets to fund essential day-to-day spending. With a backlog maintenance bill now in excess of £10bn — far greater than the total annual capital budget available to trusts in any one year — we need to grow capital investment to tackle dilapidated buildings, outdated equipment and obsolete IT. That means making sure the New Hospitals Programme can finally gain traction, making long-overdue decisions and delivering modern buildings that will improve patient care and safety.
We must also take a longer-term strategic view to bolster the resilience of the NHS to meet the demands of our changing, growing population. About one in five people aged 50-65 who have given up work are waiting for NHS treatment. Yet NHS spending has a positive impact on economic outcomes and levelling up regional growth with new research released last week showing that every £1 spent on healthcare returns £4 in increased productivity and employment.
A healthy society drives economic growth making the NHS an investable proposition. The government must not lose sight of this as part of its plan for prosperity.
So, now the political turmoil is abating, trust leaders are looking to the new government — with Jeremy Hunt at the Treasury and Steve Barclay back at the Department of Health and Social Care — to inject some long-termism into their thinking on health and care. The chancellor, in particular, knows only too well the risks of falling short on sustained investment in the service. He has been a vocal supporter for a fully funded long-term workforce plan. Now, working with the new health and social care secretary, is his chance to deliver.
This blog was first published by The Times Red Box.
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