First, and particularly in light of the most recent performance data, the Prime Minister is right to recognise the NHS is in need of attention. With November performance against the A&E four-hour waiting time standard the worst on record and the NHS now routinely missing many of the national waiting time standards enshrined in the NHS Constitution, there is an urgent need for the government to focus time, energy and resources on stabilising services.
Key to fixing NHS performance will be tackling the workforce crisis, given the scale of vacancies (more than 100,000 across hospital and community services). The government’s manifesto set out a raft of pledges aimed at addressing the issue, including 6,000 more doctors in general practice and a commitment to train, recruit and retain an additional 50,000 nurses by 2024/25. Such ambitious targets, while necessary given the scale of the challenge, will be tough to deliver, and will depend in part on the detail underpinning the government’s immigration policies and the new ‘NHS visa’.
On money and reform, the election result is likely to mean a period of continuity for the NHS, at least in the short term. On reform, the government has indicated its support for the NHS’s own long-term plan, implementation of which should now also be made easier with legislative change on the very near horizon. If, as anticipated, this legislation is based on the targeted proposals NHS England and NHS Improvement has developed in conjunction with stakeholders, it should help to accelerate the integration agenda, making it easier for NHS organisations and their local partners to collaborate.
On money, the previous government set out a five-year funding settlement for the NHS in 2018 and the Prime Minister has committed to enshrining this in legislation. While this will be a welcome increase on what came before, it will be important to be realistic about what can and can’t be delivered within this settlement; the NHS will still be required to take tough decisions in the years ahead. However, the manifesto was silent on funding for some other key areas of spend outside NHS England’s budget – this will need to be addressed in the forthcoming Budget, due to take place in February, and a Spending Review, which we eventually expect to take place later in the year. An immediate priority will be to announce local authorities’ core funding allocations for 2020/21 so that local government is clear about the funding they will have available for social care and public health services come April.
The government’s manifesto contained scant detail on both public health and mental health. There are two ways of reading this – either as a lack of commitment or as an opportunity for the sector to help the government shape its agenda over the next five years. In an effort to be optimistic, I favour the latter interpretation. A priority here will be to revisit funding for public health, which has seen its funding progressively cut since 2015/16 with significant consequences for local services.
Social care was notable by its absence from the Prime Minister’s victory speech. Despite his pledge back in July to ‘fix the crisis in social care once and for all’, the manifesto was disappointingly light on detail, committing only to a limited amount of additional funding to help stabilise the system in the short term and cross-party talks on broader reform. However, with the size of his majority, the Prime Minister now has a real opportunity to deliver fundamental change and fix a system that is widely recognised as unfair and not fit for purpose. Reaching out across party lines and devoting some of his political capital to solving what is arguably one of the greatest unresolved public policy issues of our time would be welcomed by many.
Obviously, it would be remiss (and naïve) of me, given what this election is widely viewed as having been about, not to mention Brexit. The Prime Minister has already made clear that he intends to ‘get Brexit done’ quickly and aims to get the legislation through parliament by the end of January. This will mean ‘no-deal’ is taken off the table, at least for now, which will be welcomed by most, not least in the NHS and social care sectors. But the withdrawal agreement is just the first stage – there will be plenty more to follow that could have an impact on health and social care, the trade deal in particular. We will, of course, be monitoring developments closely, so watch this space.
The strike of the nurses in Northern Ireland shows that the NHS needs political (as well as monetary) support. The same applies to GPs in charge of CCGs, who have been denied that support since 2012. The solution is to persuade MPs in Northern Ireland to work together in Stormont, and councillors on HWBs in England to work together with GPs in CCGs in England. However, the local health budget (totalling £80bnpa) should be devolved to HWBs, and the CCGs should be their executive arms, by tweaking the Health and Social Care Act 2012.
I’m afraid Helen, that you have completely ignored the elephant in the room: the absolute devastation that successive governments have wrought on the NHS through privatisation by stealth; private finance initiatives; starving the service of funds, and the abdication of responsibility to provide a public service, free at the point of delivery (The Health and Social Care Act 2012).
Unless steps are taken to mitigate this disaster and call a halt to further privatisation (and preferably reverse it) I’m afraid that the NHS will end up paying more to service its debts than it will be receiving from public funds.
It is naive to think that this government will do this without fierce pressure and demands made both by the public and those working in the NHS.
I am grateful to The King’s Fund for helping me to conduct research and answering my questions, so that I was pretty much aware of what was going on, even before seeing the John Pilger film. Now I know that the NHS crisis was deliberate government strategy, I am really angry. I think The King’s Fund should be too!