1/12 NHS financial management and funding always an important issue. @CommonsPAC hearing evidence from @DHSCgovuk and @NHSEngland on NHS financial management and capital expenditure today. @NHSProviders submission here. Several important issues to raise. Twitter thread follows.
2/12 Commenting on the usual basis: we are not the Government, we are not @NHSEngland, we are the voice of the 217 ambulance, community, hospital and mental health NHS trusts and foundation trusts. You can find the basis of all our public comment here: nhsproviders.org/news-blogs/pre…
3/12 Before COVID, NHS working towards financial recovery by 2023/4, as per Long Term Plan. Always v stretching task: avg annual real terms growth of 3.4% well short of 5% @TheIFS/@HealthFdn said was needed to keep up with demand growth, recover performance & transform services.
4/12 It has always been acknowledged that the NHS Long Term Plan (LTP) could not be delivered without a much-improved capital settlement. This has not yet been put in place. The earliest it could be in place is now 2021/22 – the middle of the five-year LTP period. A problem.
5/12 We don’t yet know how 2019/20 will end, but the data we do have underlines just how difficult it’s going to be to turn around NHS finances. At month 10, before covid-19 hit, providers were already forecasting a year end deficit of above £800m – over £500m more than planned.
6/12 COVID-19 has suspended business as usual for trust finances: providers are being paid on block contracts based on cost. This was the right thing to do to enable them to focus on responding to pandemic. But it also means progress on financial turnaround has been suspended...
7/12 ...For example, every trust leadership team will tell you how much energy, focus and time has to go into delivering the very stretching cost improvement programmes recently required of NHS. A lot of this energy, focus & time has rightly been devoted to tackling coronavirus..
8/12 In any case, what providers are being asked to deliver for money allocated has changed completely in past three months. These changes will evolve, but they are not temporary. Overall, the medium-term impact of COVID-19 will be to significantly increase trusts’ costs.....
9/12 ..Trusts will need to retain surge capacity, support large amounts of testing, care for covid-19 patients in hospital/community, use space less efficiently to keep social distance, treat extra mental health demand, buy more PPE. List of extra costs/lower efficiency v long!
10/12 Obviously, this will require additional financial support. The LTP was the NHS’s side of a bargain with the government in 2018: a transformed service in return for extra investment. It is now clear that the NHS is in a very different place.....
11/12 As we move into the next phase of the service’s respond to COVID-19, we will have to reconsider the LTP goal of full financial recovery by 2023/24 and collaboratively develop a new mid/long term financial regime for the NHS. In the meantime it's really important that....
12/12 In the short term it's very important to strike the correct balance between reimbursing trusts for costs they are legitimately incurring whilst minimising bureaucracy and creating the right incentives for efficiency and financial control.
