Unfinished business on funding jeopardising NHS plan

A new report has argued that delivering the ambitious vision of improved care for patients set out in the new NHS Long Term Plan will be extremely challenging without urgent government action on wider health funding.

Analysis by the Health Foundation and NHS Confederation finds that, with over-stretched, under-staffed services and poorly maintained facilities, the health service will continue to struggle in the face of rising demand.

The Health Foundation report and NHS Confederation survey both support the vision of the NHS Long Term Plan, but they argue that success or failure will depend on whether the government commits to supporting investment in the workforce, capital infrastructure, the prevention agenda, and social care. These areas of funding were excluded from the five-year NHS funding settlement, announced last year.

Under the new funding settlement, NHS England’s budget is set to increase by £20.6 billion in real terms. But to meet growing patient demand, hospital activity will need to rise by at least 2.7 per cent a year by 2023/24. The Health Foundation’s new analysis reveals that if NHS earnings are to keep pace with wage growth for other professions, the extra money will only enable hospital activity to grow by 2.3 per cent over this period. Managing demand to this extent would require a major change to recent trends – demand for hospital services has increased by three per cent a year since 2010/11.

Front-line NHS leaders responding to the NHS Confederation survey say reducing demand for acute care through better integration and prevention is essential. But they are not confident of this being achieved – only one in four leaders believe their local health systems will be able to reduce the rate of growth in demand.

While endorsing NHS leaders’ vision of more preventative care, integrated community services, and better-coordinated urgent care, the briefing and survey caution that investment in the areas of social care and public health will take time to have an impact on people’s use of hospitals.

Jennifer Dixon, chief executive at the Health Foundation, said: “The vision set out by NHS leaders in the long-term plan is the right one, and the extra funding announced by Theresa May last summer is welcome. But this is not job done.

“Policymakers need to face the fact that there is urgent unfinished business if the NHS is to deliver its vision to improve patient care. There are mounting workforce shortages, the social care system is starved of funding, capital investment is going backwards, and public health funds cut. This all piles demand on the NHS and risks swallowing up the extra money and leaving far less to modernise care, reduce waiting times, and prevent illness in the first place. The NHS is being seriously hampered in efforts to move forward. How can any industry significantly boost productivity without investing in staff training, technology and kit?

“The new government needs to honour last year’s promises to set out long-term funding for public health, capital investment, workforce training and social care, and ensure they receive sufficient funding to support the long term plan ambitions.”

Niall Dickson, chief executive of NHS Confederation, added: “The NHS is on the move – many parts of the country are delivering pioneering changes to keep more people well and out of hospital. As our survey shows, NHS leaders are optimistic about the future and want to deliver the vision for more care in the community, backed by technology and new ways of working.
 
“But they also have serious concerns. They face crippling staff vacancies, rising demand for care, lack of investment in buildings and equipment, and the drastic cuts to social care and public health that are fuelling extra demand on A&E and other front-line NHS services.
 
“Failure to address this in the next spending review will put the ambitions of the NHS plan in jeopardy, and patients will not feel the full benefits of the extra £20 billion of funding. This may look like a bounty when compared with other public services, but it will not be enough unless there is investment in those other neglected areas. The ambitions of the plan are not only highly desirable but NHS staff have a chance of achieving them if the government sticks to its promise of investing in social care in particular.  And given the huge extra demands, we need much more honesty from politicians about what can and cannot be delivered over the next decade.”