There’s a Budget coming on 11 March and there’s interest building to see how far the financial taps will be turned on – and how all that extra government spending will be paid for.
One of the big spending promises involves the NHS. Messrs Johnson/Cummings have fixed the Treasury – and they may already have plans lined up to fix the NHS.
We may be on the verge of a major re-casting of the way the NHS is governed. The Prime Minister thinks the head of the NHS, Sir Simon Stevens, has too much power – and Mr Johnson wants some of it back.
This will matter to our local NHS services. Money is going to be tight as the NHS makes up for austerity and the minimal funding increases of the last nine years. So it could matter very much.
Already Boris Johnson has made a bid to smother those erroneous promises for the NHS funding painted on the side of his Leave battle-bus. He has resorted to a Parliamentary Bill to give back bone to his promised new funding figures – that extra £33.9 billion each year until 31 March 2024. It should become law by the end of February.
The NHS Funding Bill is now making its way through Parliament – though it is not being much reported or commented on in the mainstream media. It is a ‘one-clause’ Bill that sets out the minimum amount the Secretary of State must ‘allot’ to the NHS in England over the next four years.
In the first debate on the Bill, Health Secretary Matt Hancock called it “…the largest and longest funding settlement in history.” But it is a cash promise not a promise of real term increases – so it does not allow for inflation.
You could have some fun questioning whether it is the longest or the largest funding in the NHS’s history – let alone ‘in history’. In fact the figures in the Bill equate to 3.4 per cent rises – though some say it is 3.3 per cent. Over all the years since the NHS was founded, annual funding increases have averaged at 4 per cent and during the Blair/Brown years they averaged 6 per cent.
The Bill says just one thing about how the money can be spent. It must be used as a ‘revenue resource’ – i.e. spent on everyday costs. It is not to be spent on investment or capital projects.
So what are the odds on this very welcome money (welcome whether or not it is just a re-badging of the money Theresa May promised) getting through to those famous ‘front line services’ – where there are too many queues, where the trolley waits are too long, where there are too few MRI scanners, where there are too many leaking roofs and where nurses and doctors are too few?
This Bill makes no changes in the duties or responsibilities of the Secretary of State or the head of NHS England. So for now delivery will follow the organisational trend of the Ten Year Long-term Plan. This means CCGs (including merged ones like ours) having less say on how the budget is divided up locally, as larger units gain most of the power. These units are known as ‘systems’ or ‘local care groups’ or ‘Integrated Care Systems’.
One thing is sure: the Treasury (now to be known as ‘No 10’s Treasury’?) has a long track record of clawing back many millions of pounds it has handed to the NHS. So, for example, NHS Property Services will continue to charge market rates for premises it has been given. Hospitals will continue to face up to 150 per cent rent rises.
There are three great fears. First, that hospitals, many of which have had to take out huge government loans to beat austerity and stay afloat, will use the new money to pay off those loans and escape heavy interest charges.
The answer is that the government must write off these loans (GWH has outstanding loans totalling about £25 million). Or they must turn them into Public Dividend Capital. This means the Treasury would hold shares in each Hospital Trust, which would then pay less interest or none at all.
Secondly, there is a real fear that this promised funding will simply eat away at that other part of the government funding – capital spending. This has been the case in many parts of the NHS during the austerity years.
It is not yet clear whether Sajid Javid’s order (before he resigned as Chancellor of the Exchequer) for cuts of five per cent across government departments will follow him out of the Treasury door or whether his departure will herald a major loosening of the purse strings. However, the NHS shopping list is long and costly.
The political list of promised improvements to the NHS was put clearly in Parliament by a Conservative MP: “…it is this Conservative Government who are delivering on that, with 40 new hospitals, 50,000 new nurses, 6,000 more doctors, 6,000 more primary care professionals, 50 million more GP appointments and free car parking for those in most need.” A longer list than that chanted at the first meeting of the new Cabinet.
But that is just what shows above the political horizon – or in the headlines. Below it there is a multitude of major capital spending projects – like GWH’s new Emergency Department.
No mention in that list of the country’s shameful shortage of MRI scanners. No mention of the other staff shortages – radiologists (60 per cent of radiologist vacancies have been unfilled for over a year), consultant psychiatrists (a ten per cent shortage) – or of the huge backlog of maintenance and repair work postponed during the austerity years (the bill for England is estimated at £6.6 billion), – or of the 300,000 NHS workers waiting for the Tories’ pledge to raise the National Living Wage to £10.50 an hour by 2024 bringing a large increase in the NHS’ pay bill…and so on and so on.
On top of it all will be the costs of turning the NHS carbon neutral. Just one example: Nottingham City Hospital needs £24 million over two years to replace its coal fired central heating boilers.
Thirdly, a sustainable future for the NHS relies significantly on a reformed, securely funded and well-run care sector – both care homes and care at home. Nationally, with two care homes closing for every one opening, a huge annual turnover of staff and the government’s new immigration rules, hospital beds will continue to be blocked by patients who, though fit enough not to stay in hospital, cannot be released without safe and secure care at home or in a care home.
One day early this month, Great Western Hospital did an analysis of the 74 patients who were ready to leave the wards but did not do so. Fifty of them were waiting for something outside GWH’s control – though not all of those delays were down to social services. And across England this month, the number of blocked beds has started to rise again.
Whatever happens over the next few weeks as the Johnson cabinet settles in, NHS services in our area need to be watched very carefully. What happens, for instance, if the new Conservative voters in the north of England are rewarded with NHS largesse, while constantly Conservative areas like ours are left to wait for better times.
If ‘levelling up’ comes to mean starving our area of NHS cash, we may all have to become Levellers.