The Budget must acknowledge the scale of the recovery challenge for NHS
25 October 2018
NHS Providers warns that much of the funding increase outlined for the NHS by the prime minister risks being swallowed up by efforts to recover performance after almost a decade of austerity.
In its budget submission to the Treasury the organisation representing all 227 acute, mental health, community and ambulance trusts in England says although the 3.4% real terms funding increase is very welcome, particularly in comparison to funding for other public services, the ongoing gap between growing demand and funding levels over the last 9 years has left services catching up against key targets.
The performance of the sector is also being undermined by the difficulties for trusts to recruit and retain the staff they need to meet demand. At present, the numbers of clinical staff in education and training are not growing as required to meet the needs of an ageing population.
The workforce challenge is being exasperated by more and more staff leaving the service as a result of the increasing strain and the impact of accumulated years of pay restraint.
The paper also points to a need to properly invest in public health, social care services and other areas of the service which are not included within the funding uplift including workforce training and capital budgets for buildings and major investments.
It highlights a series of challenges faced in each of these areas, and the knock-on effect that underfunding these services has on the NHS. It warns:
- As demand has now outpaced funding levels for almost a decade of austerity, filling the gaps in performance that have opened up in the health service will account for much if not most of the new money
- The supply of key skills has not kept pace with rising demand for services, safe staffing requirements or the growth of inpatients with more complex care needs as a result of our ageing population
- Health and social care are dependent on one another, but most local authorities are seeing their budgets cut at a time when demand for social care places is growing
- Public health budgets have been eroded in in recent years despite the threat that preventable ill health poses to the longer term sustainability of the health and care system
- Underspending on capital projects is contributing to a growing backlog of maintenance issues and delaying trusts from digitising services and moving to more streamlined ways of delivering care.
- Brexit continues to bring uncertainty to the NHS with workforce numbers as well as the supply of key services and supplies including medicines, equipment, fuel and food.
In response, NHS Providers calls on the chancellor to:
- Commit funding to develop the existing workforce through education and training and set aside adequate funding to employ the growing number of staff the NHS will need over the coming years
- To use the Budget to ensure that the social care sector is put on a sustainable footing
- Reverse cuts to public health budgets to shift the balance towards longer-term investment
- Ensure that sufficient funding is made available for capital, particularly given the limits of land sales and alternative funding sources
- Put in place measures to ensure the NHS does not face additional costs and ensure funding levels are maintained as a result of Brexit.
The deputy chief executive of NHS Providers, Saffron Cordery, said:
“All eyes will be on the chancellor to set out how the welcome funding uplift for the NHS will be paid for and what the NHS will be expected to deliver.
“As this long-term plan is drawn up for the NHS, we have to be realistic about what can be delivered amongst competing priorities for this funding. After almost a decade of austerity in which growing demand has outstripped funding increases significant gaps against key performance targets have opened up. We must be honest about the time and investment it will take to recover this performance and the impact that will have on other commitments. We hope the chancellor acknowledges this.
“The challenge of recruiting and keeping the staff that the NHS needs to meet the demand asked of it is the biggest concern for trusts. It is imperative that funding for training and education is committed if we are to fund the additional training places, and incentives to bring and retain the talented staff the NHS needs.
“For this additional funding to provide maximum benefit, we must see investment in wider services that the NHS critically depends. Social care and public health budgets are seeing further cuts while demand just grows and grows. Health and care services are intertwined. This underinvestment risks devaluing every pound of investment in the NHS.
“Brexit remains a significant uncertainty for the NHS – both in terms of workforce and the impact of costs associated with the UK’s exit from the European Union. The chancellor must use the Budget to reassure the sector that the NHS will not face additional costs and that funding levels will be maintained following Brexit.”