To manage this winters risk safely the NHS needs extra capacity, focusing on the most vulnerable systems. Specifically, this means:

  • Additional investment to create the extra NHS capacity which the £1bn for social care was intended to deliver but has failed to consistently produce.
  • It is impossible to quantify exactly how much extra capacity is needed or how much this will cost. But the significantly better national data gathering around bed capacity will give as good an estimate as any. Our estimate is that a minimum investment of £200m is required, with our original June estimate of £350m a more comfortable figure.
  • This extra investment should be concentrated in the systems identified as being most at risk in the segmentation, with particular emphasis on those systems where the extra social care investment is not flowing to the NHS’s benefit and where the capacity gap is greatest.
  • NHS Improvement and NHS England should set out clearly which systems they believe, from current data, should benefit from how much extra investment. System leaders should, however, be realistic about how much detail on how the investment will be spent can be given at this point. Local system leaders are best equipped to determine whether the best use of any extra money is in mental health, community services, primary care, social care, ambulance services or acute hospital capacity. They will take time to reach the best decision and then create the required capacity. The key principle is that the funding needs to flow as quickly as possible to local systems.
  • A decision on extra funding must be made as soon as possible so that local systems can plan with certainty and the investment can be used in the most effective and efficient way. Every further day’s delay means higher temporary staffing fees and less chance of actually creating the required extra capacity.
  • In terms of funding this investment, there are two options. The first would be to make the £200m-350m sum a repayable advance or an early draw down from the extra £8bn committed to the NHS in the Conservative manifesto. The second is to argue that, as the NHS will spend £109bn on frontline care in 2017/18, the emergency winter investment represents between 0.2 and 0.3% of that sum. Given this relatively small size, it seems reasonable for the NHS to fund the required investment from this overall allocation, as opposed to seeking further new funding from the Treasury. But this must not be at the expense of existing expenditure on services that are key to winter performance such as primary care, community care and mental health care. If need be, given the urgency, this investment should be made at risk and treated as part of the year-end reconciliation.