What’s been promised?

Below are the main NHS related headline announcements following Philip Hammond’s Autumn budget, delivered last week. In a promise to “always back” the increasingly pressurised health service, the Chancellor has announced a pot of extra funding to supplement the formal funding review process.

  • Hammond has announced a £2.5bn funding injection for the NHS over the next two consecutive financial years – these are one-off payments added to the planned budgets in each year.
  • Of this £2.5bn, £1.6bn will be added to the 2018-19 budget, seeing the £124.5bn budget originally planned for the year rise to £126bn.
  • The remaining £900m is reserved for 2019-20.
  • The NHS will also receive £335m this year, to aid winter pressures.
  • The Health Service Journal (HSJ) reports, for the 2018-19 pot, £1bn of the extra funding is intended to stop the declining performance in elective care. Research by Monitor, sector regulator for health services in England, suggests the NHS could improve productivity in elective care by up to 20%. For example, by rating patients on risk and simplifying pathways for the low risk patients or implementing ‘day-of surgery admissions’.
  • Hammond’s extra £600m in 2018-19 is aimed at helping hospitals meet the A&E target ­– for patients to be admitted, treated, and transferred or discharged from A&E within four hours.
  • An additional sum has been promised to fund pay rises for nurses and other key staff on top of the announced £2.5bn, if agreements are made regarding Agenda for Change new contracts.

Reactions

There were mixed reactions across key personnel and commentators, with a common thread that whilst the increase would ease immediate pressures, the governments expectations are unrealistic in terms of what can actually be done in return. Social care and Mental Health, it was noted, remained worryingly in the background.

Richard Murray, Director of Policy for The Kings Fund  –  “The additional money for the NHS is a welcome shot in the arm as a service struggles to meet rising demand for services. But it is still significantly less than the £4 billion we estimate the NHS needs next year. Even with this additional funding, the NHS will struggle to meet key targets and provide the investment needed in services such as general practice and mental health.”

Murray noted his disappointment that extra funding was not found for social care which faces a significant funding gap by 2019/20.

NHS England Chairman, Sir Malcom Grant – "The extra money the Chancellor has found for the NHS is welcome and will go some way towards filling the widely accepted funding gap. However, we can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available. The NHS England board will need to lead this discussion when we meet on November 30."

Professor Sir Bruce Keogh, national medical director for NHS England – “Personal view...Budget plugs some, but def not all, of NHS funding gap. Will force a debate about what the public can and can’t expect from the NHS. Worrying that longer waits seem likely/unavoidable.”

One of the strongest reactions came from Claire Murdoch, NHS England’s National Director for Mental Health, who tweeted – “Both as national director for MH and as a trust CE, I am deeply concerned at where this leaves us. We cannot jeopardise 5yrfv MH deliverables and my Trust (and colleagues') cannot go on making 6% CIPs year on year...not to mention social care! Some very very tough choices ahead.”

The funding announced was largely seen as insufficient; being less than half of what experts had suggested was needed for next year alone. As the HSJ report, the next NHS England board meeting will provide a timely opportunity in which to fully understand the opportunities within the funding increase and what can realistically be delivered.

References

http://www.bbc.co.uk/news/health-42082602

https://www.theguardian.com/uk-news/2017/nov/22/philip-hammond-housing-nhs-autumn-budget

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/466895/Elective_care_main_document_final.pdf

https://www.gov.uk/guidance/improving-productivity-in-elective-care

https://www.hsj.co.uk/finance-and-efficiency/chancellors-funding-announcement-plugs-some-holes-in-nhs-budget/7021130.article

https://www.hsj.co.uk/finance-and-efficiency/which-of-the-children-do-we-shoot-first-the-budget-leaves-the-nhs-with-harsh-choices-/7021134.article

https://www.theguardian.com/uk-news/2017/nov/22/budgets-16bn-cash-boost-for-nhs-less-than-half-of-experts-advice

https://www.hsj.co.uk/finance-and-efficiency/the-budget-has-placed-the-nhs-and-government-on-a-collision-course/7021134.article

https://www.kingsfund.org.uk/press/press-releases/kings-fund-responds-2017-autumn-budget?utm_source=twitter&utm_medium=social&utm_term=thekingsfund

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