1/23 Health and care funding now centre stage as Govt sets 2nd half 2021/22 & longer term Spending Review settlements. Great article by @michaelsavage & @denis_campbell here: theguardian.com/society/2021/a…. My accompanying comment piece here: theguardian.com/society/2021/a…. Thread follows.
2/23 Health & care budget central to spending review, given the size of spend, so strong case to settle early. NHS budget for second half of 2021/22 must be set by end September. Increasingly likely this could be a single NHS money discussion, concluded relatively rapidly.
3/23 Decisions made here, over next two months, likely to set health and care funding for next three years. They will impact the health of our nation for a generation. So they’re very important to get right. They could also have a significant impact on the next General Election!
4/23 Context is key. Between 2010 and 2019 the NHS suffered the longest and deepest financial squeeze in its history. NHS funding rose by just 1.4% a year, on average. Given that demand for NHS services was rising by approximately 4% a year, the result was all too predictable...
5/23 ...Despite best efforts at NHS frontline, waiting lists grew, A&E performance dropped and the NHS capital backlog bill ballooned to £9 billion. NHS staff became unsustainably overstretched as they worked harder and harder to cover the growing gap between demand and funding.
6/23 In June 2018 Theresa May announced a 5 year NHS revenue funding settlement. But this was never the bonanza many claimed. NHS funding to 2023/24 increased by 3.3% a year. But this was below long term avg annual 3.6% increases NHS has received since its creation in 1948...
7/23 ...And the settlement assumed NHS could continue making the near record efficiency savings it realised across most of the 2010’s. Three things have happened since which have massively changed this context, meaning that the imminent new settlement must reflect new context.
8/23 Change 1. This Government was elected on an election manifesto that promised 40 new hospitals, 50,000 extra nurses and 50 million new GP appointments. These require significant increases in NHS capital and education budgets not covered by the June 2018 settlement or since.
9/23 Change 2. Social care system has tipped further into crisis, making properly funded social care reform an immediate necessity. Change 3. A COVID-19 pandemic, creating a much larger forward task for an already over-stretched system (including a larger pay rise than planned)
10/23 The costs of COVID-19 will be here for a long time to come. Record levels of care backlogs to recover. A robust surveillance system to track new variants. Effective test, trace and isolate. Extra personal protection equipment. Likely annual booster vaccinations…
11/23 ...Treatment for large numbers of long covid and mental health patients created by the pandemic. The NHS will have to carry on with right levels of infection control in many areas of activity to ensure we keep patients safe from covid-19, reducing efficiency…
12/23 ...The NHS will also need the right capacity to cope with further COVID-19 waves. Experts are clearly saying that we should expect more of these over the next few years. They're more likely to arrive in the winter months when the NHS is at its most stretched.
13/23 The care backlogs, in particular, look daunting. And we still don't know the full size of these backlogs. But, don't forget, the NHS has tackled comparable waiting lists in the early 2000s. However it was supported by several successive years of 7% plus funding increases.
14/23 Trust leaders acknowledge and welcome fact that Chancellor has, up to now, largely met his pledge of giving NHS what it needed to cope with COVID-19. This has been essential to NHS delivery over last 18 months. But, recently, Treasury mood music has sharply switched...
15/23 ....Treasury is now emphasising the importance of recovering the national finances and reducing the NHS share of public spending. With a worryingly misplaced assumption that COVID-19 costs will fall quickly, so the NHS can return to its ‘generous’ June 2018 settlement.
16/23 Frontline NHS leaders clear that they can’t provide the quality of care patients need, and deliver the Government’s manifesto commitments, unless they are properly funded to do so. As a nation, it's key to remember that we get the quality of care we're prepared to pay for.
17/23 To clear surgery backlogs, trusts will have to deliver much higher levels of elective surgery activity than they were doing pre-pandemic. They can only do this with substantial new investment in extra diagnostic equipment, new technology and new ways of working.
18/23 Although the media focus is usually on elective surgery waiting lists, similar challenges apply to meeting growing patient demand for ambulance, community and mental health services. They are under just as much pressure and new investment is needed here too.
19/23 Trust leaders can only build 40 new hospitals, maintain safe estates and tackle the £9 billion estates & equipment backlog with the right capital funding. And to ensure a sustainable workload for NHS staff, they need a fully funded long term workforce plan.
20/23 The NHS has traditionally been very efficient by international standards. But it will take time to regain the stretching level of efficiency savings assumed in May Govt settlement. We have much less slack in our system (e.g. much higher levels of bed occupancy) than others.
21/23 SUMMARY: a really difficult five fold problem here. A May settlement that was never as generous as some pretended; a set of expensive new manifesto commitments; a social care crisis that must now be solved; a massive care backlog to recover; and ongoing Covid costs...
22/23 ...Any one of those by themselves would be a major pressure. The problem is the combination of all five at once. However, covid vaccination programme and early 2000s waiting list clearance shows that when the NHS has the financial support it needs, it delivers. In spades.
23/23 NHS frontline leaders are clear that very large challenges lie ahead. They believe they can, and are ready to, meet them. But they can only deliver if they get right funding decisions over next two months. Otherwise there's a real danger that patients will pay the price.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
