For the NHS to realise the ambitions of the NHS long term plan (LTP), meet rising and changing demand and continue to support the government’s ambitions of a prosperous society, it will require appropriate, and additional, investment. The forthcoming comprehensive spending review will provide a welcome opportunity to review the medium term needs of the health and care sector and to debate the funding required to meet public need and expectations of the health service.

In this representation we set out the pressing issues that require urgent attention and resolution within the budget for 2020/21 in order to meet the ambitions of the LTP:

• Ensuring the 2020/21 capital budget increases to reflect the additional £1bn allocated in 2019/20 to ensure trusts do not have to cut back spending on increasingly safety critical issues with buildings and equipment. This should be accompanied by a commitment to a minimum four year capital settlement in the forthcoming comprehensive spending review including recognition of the investment needed for mental health, community and ambulance services.
• An explicit extra revenue commitment for the NHS to support the first year of implementing the People Plan, in the expectation that a non ring fenced, multi year revenue settlement will be forthcoming in the spending review which takes into account of the funding required to deliver the combined aspirations and commitments within both the People Plan and the LTP. 
• A definitive solution to the NHS pensions problem applicable to all staff including managers and clinicians. This solution must look to resolve this issue definitively and fairly, including amending the taper and addressing the impact of the annual allowance for all staff moving into senior roles or through pay increments. 
• Urgent additional revenue for social care for the next financial year while a longer term solution is explored on a cross party basis and in consultation with the public. 
• Appropriate investment in public health.