Comment / Funding – a closed case?

It's a case of 'as you were' for the NHS following last month's general election. That is certainly how it seems on face value.

The different parties had set out different funding proposals in their manifestos. They had confusingly used different ways to describe this funding – making comparison less than straightforward. But the general conclusion of NHS commentators was that the Conservative proposals offered the smallest direct investment in health services over the next five years. 

What they offered with their £8bn in real terms over five years was basically the already announced spending plans extended by two years. There is a small bonus of promising real-terms per capita growth for each year of the Parliament, which changes the existing spending profile – although we have heard nothing more about this. We are also promised £10bn in capital spending, but in line with the Naylor report, not all of this will come from the taxpayer.

The vociferous calls during the campaign to meet the service’s clear challenges with more appropriate levels of additional funding have gone unanswered. And so that is that in terms of funding – or is it? The election may not have triggered a change in government, but it looks set to have an impact on the style of government and maybe soften its ‘austerity at all costs’ approach.

No-one in NHS finance would plan for a funding boost in the short term. As HFMA president Mark Orchard says, it’s a case of roll your sleeves up and focus on submitted plans.

But there are other things at play here. There have already been hints that the 1% public sector salary cap could be reviewed. Many leaders in the NHS would back such a move given the efforts of staff in recent years and the importance of staff buy-in to the transformation agenda. Surely such a move would have to be accompanied by an adjustment to the NHS settlement? It would be fanciful to expect providers to cover this cost pressure within existing budgets.

Of course a funding change to accommodate increased pay wouldn’t help trusts address current imbalances. But it just might provide an opportunity for a broader review of funding. There are definite signs of growing support for a less austere approach to public services, backing key areas such as the NHS, social care and public safety with more than just words.

An argument that has been put forward a number of times in recent months has been that the NHS cannot ask for extra money before it has eliminated the waste from its existing systems. National programmes such as Getting it right first time have already flagged up significant variation across orthopaedic surgery and it has moved on to other areas. RightCare data also suggest there is significant potential to address variation and release cost.

But the existence of potential efficiency opportunities should not rule out the need for additional resources. There is clearly major potential to improve services for patients and reduce costs by addressing variation in clinical and support services. But these opportunities will not be realised overnight.

Clinical engagement and leadership will be vital to driving this agenda. But that is difficult without the headroom to allow them to lead. In some cases that will need additional staff to backfill shifts to enable fast progress to be made with transformation. It will also take time if transformation is done properly – which it has to be – involving public consultation, understanding and support for local change programmes.

The system-wide approach to developing new models of care and responses to major service pressures is the right one. But insufficient funding might mean it takes longer to achieve. And maybe a change of mood among the public and a government more in listening mode might bring this issue back onto the table.