The COVID-19 pandemic has created a climate of economic uncertainty and upended government finances. It has also brought new pressures to the NHS, which for years had already been running at – and sometimes beyond – full stretch. The effects will be felt in the NHS and wider public services for a long time.
We had hoped this month's comprehensive spending review would cover the next three or four years, to provide the certainty and the money the NHS needs. But we now know that the spending review will largely only cover 2021/22. Although a comprehensive, multi-year settlement would have been better for the NHS, we understand the unique fiscal circumstances that have led the government to opt for a one-year spending round.
Reviews are about identifying priorities and ensuring adequate resource is allocated to them. For the NHS, there are five issues related to the ongoing impact of COVID-19 and promises made in the 2019 Conservative manifesto on which the government will need to make progress.
Ministers pledged to build 40 new hospitals, and will need to make a multi-year commitment to funding them. They also pledged to provide 50,000 more nurses and 6,000 more doctors, and so training budgets will have to rise to enable an increase the domestic workforce supply.
Reviews are about identifying priorities and ensuring adequate resource is allocated to them.
To tackle the backlogs in planned care, the NHS will need more money for diagnostic procedures and elective surgery, as well as more hospital beds to support this increased activity. The pandemic has also led to an increased demand for mental health services and exposed funding pressures on ambulances. Increased capacity must be created to deal with this.
Finally, social care needs to be supported with appropriate funding to ensure services remain operational in the near future. And to avoid hospitals filling up with medically fit patients whose beds are needed by others, the one-off £588m pot to support trusts and local authorities to safely discharge patients should be renewed and added to core revenue funding.
As the government finalises its plans, ministers must remember that there should not be any trade-offs between its existing commitments and other essential areas of NHS spending.
Existing budgets are already short of what the NHS needs, and have been so for many years.
For example, on capital investment, new money for the hospital building pledge cannot be taken from existing budgets – if it is, trusts will not be able to maintain their existing estate and the care environment will get worse. Existing budgets are already short of what the NHS needs, and have been so for many years.
As a result, too many people are being cared for in cramped, crumbling buildings, the worst of which make it more likely that care will be delayed or that patients will come to harm. Under-investment has left people with mental illness being treated in totally unsuitable environments. These problems will be exacerbated, not solved, if the promised new hospitals can only be built by diverting money from the maintenance budgets of other trusts.
Meanwhile, the failure to invest in diagnostic equipment over many years has choked capacity and left trusts relying on outdated equipment liable to break down, causing disruption, frustration and delay for patients.
In mental health, the increase in demand for care is, like the surgery backlogs that have arisen this year, a direct consequence of the pandemic.
In mental health, the increase in demand for care is, like the surgery backlogs that have arisen this year, a direct consequence of the pandemic. But while the government has been willing to block-purchase private hospital capacity, there has been no equivalent deal for mental health. Without significant investment in these core services, the surge in demand will result in many critically ill people being unable to access treatment when they need it.
It is similarly essential that the government does not attempt to meet its commitments to expand the NHS workforce at the expense of other areas of spending. In the past the public health budget, arbitrarily placed outside the ringfenced NHS budget, has been cut in the name of preserving "core" services. This has been a false economy: stronger public health services at a local and national level may have helped with the response to the pandemic, and investing in preventative care always pays dividends.
Financial stability and security has been an important element underpinning the incredible frontline response to COVID-19.
Finally, NHS trusts and foundation trusts must be given clarity over their budgets for the first half of 2021/22, as soon as possible after the spending review is published. Financial stability and security has been an important element underpinning the incredible frontline response to COVID-19. If trusts do not have similar certainty before Christmas, they will be forced to make prudent assumptions about their capacity from April onwards, and potentially be forced to cut back at a time when we know the effects of the pandemic will still be very much with us.
The decision to delay a multi-year comprehensive spending review is understandable, but is nevertheless disappointing for an NHS that needs long-term financial security. It is reasonable for the government to take the opportunity to deliver on its manifesto commitments, but it must resist the temptation to prioritise those over other vital health services, and the ongoing impact of coronavirus. Otherwise, we will see the NHS slip backwards, rather than begin to recover from the pandemic.
This blog was first published in The Independent.