The autumn spending review will set health and care funding for the next three years. The decisions the government makes will impact the health of our nation for a generation. They could also have a significant impact on the next general election.
Between 2010 and 2019 the NHS suffered the longest and deepest financial squeeze in its history. NHS funding rose by just 1.4% a year, on average. Given that demand for NHS services was rising by approximately 4% a year, the result was all too predictable. Despite best efforts at the NHS frontline, waiting lists grew, A&E performance dropped and the NHS capital backlog bill ballooned to £9bn. NHS staff became unsustainably overstretched as they worked harder and harder to cover the growing gap between demand and funding.
In June 2018 Theresa May announced a five year NHS revenue funding settlement. But this was never the bonanza many claimed.
In June 2018 Theresa May announced a five year NHS revenue funding settlement. But this was never the bonanza many claimed. NHS funding to 2023/24 increased by 3.3% a year. But this was below the long term average annual 3.6% increases the NHS has received since its creation in 1948. And the settlement assumed the NHS could continue making the near record efficiency savings it realised across most of the 2010's.
Three things have happened since. This government's election manifesto promised 40 new hospitals, 50,000 extra nurses and 50 million new GP appointments. These require significant increases in NHS capital and education budgets not covered by the June 2018 settlement or since. The social care system has tipped further into crisis, making properly funded social care reform an immediate necessity. And we've had a COVID-19 pandemic, creating a much larger forward task for an already over-stretched system.
The costs of COVID-19 will be here for a long time to come. Record levels of care backlogs to recover. A robust surveillance system to track new variants. Effective test, trace and isolate. Extra personal protection equipment. Likely annual booster vaccinations. Treatment for large numbers of long COVID and mental health patients created by the pandemic. And the NHS will have to run at much lower efficiency levels to keep non COVID patients safe. It will also need more capacity to cope with further COVID-19 waves, many likely in winter when the NHS is at its most stretched. The care backlogs, in particular, look daunting. But the NHS has tackled comparable waiting lists in the early 2000s, supported by several successive years of 7% plus funding increases.
The chancellor has, up to now, largely met his pledge of giving the NHS what it needed to cope with COVID-19. But, recently, the Treasury mood music has sharply switched.
The chancellor has, up to now, largely met his pledge of giving the NHS what it needed to cope with COVID-19. But, recently, the Treasury mood music has sharply switched. To recovering the national finances, reducing the NHS share of public spending, and a worryingly misplaced assumption that COVID-19 costs will fall quickly, so the NHS can return to its 'generous' June 2018 settlement. Frontline leaders can't provide the quality of care patients need, and deliver the government's manifesto commitments, unless they are properly funded to do so.
They won't be able to reach the much higher levels of activity needed to clear surgery backlogs without substantial investment in extra diagnostic equipment, new technology and new ways of working. Similar challenges apply to meeting growing demand for ambulance, community and mental health services. They can't build 40 new hospitals or maintain safe estates without the right capital funding. They can't ensure a sustainable workload for NHS staff without a fully funded long term workforce plan.
The COVID-19 vaccination programme shows that when the NHS has the support it needs, it delivers, in spades. NHS frontline leaders believe greater challenges lie ahead. The spending review will be crucial in enabling the NHS to meet these challenges. Otherwise patients will pay the price.
This blog was first published by the Observer.