Calls to revisit funding settlement

by Seamus Ward

19 August 2020

Healthcare leaders have called on the government to look again at funding for the NHS, public health and social care, with hospitals, GPs and care homes facing rising costs and the Covid-19 pandemic highlighting the need to prioritise public health.

This week England’s health and social care secretary Matt Hancock announced he would create a new public health body, the National Institute for Health Protection (NIHP). The institute will bring together Public Health England (PHE) with NHS Test and Trace and the Joint Biosecurity Centre. Though they will work together under the interim leadership of Dido Harding – the head of Track and Trace – the new body will not be formalised until spring next year.Chris Hopson

Mr Hancock added: ‘[The NIHP] will ensure the UK will be in an even stronger position to deal with and further recover from Covid-19, the strongest possible position to meet the health protection challenges over the coming winter and be more resilient to respond to future pandemics.’

However, NHS Providers chief executive Chris Hopson (pictured) said the axing of PHE was ‘a wake-up call’ and the country should ‘act accordingly’.

‘As a nation we’ve failed to properly prioritise or fund public health in recent years and that came back to bite us hard as Covid-19 hit, even though a global pandemic was top of the list of national risks.

‘Years of underfunding for Public Health England, and public health work more widely, has resulted in the UK not being properly prepared to tackle a pandemic such as Covid-19. For example, the local authority public health grant has been cut by 25% in real terms over the last five years.’

He insisted that many of the successes during the pandemic were due to Public Health England, while many of the failings were due to government as a whole. NHS Providers agreed with the logic of combining PHE and Track and Trace, but said the government must clarify what will happen to PHE’s wider responsibilities for addressing the determinants of health and reducing health inequalities.

The recent phase 3 planning guidance emphasised the role of local NHS systems in addressing ill-health and for reducing health inequalities.

Speaking about funding more generally, Mr Hopson said the five-year settlement unveiled in 2018 by Theresa May’s government – which promised the NHS an extra £20bn by 2023 – must be revisited. There were two elements to this – funding for the rest of 2020/21 and the spending review, which he said would set the NHS revenue budget for three years and capital funding for the next four.

Talks were ongoing over funding for the rest of the year, but the NHS faced significant risks over the winter. And, though the service had received an extra £300m in winter funding, its requests had not been met in full – for example, calls for a permanent increase in acute beds and to bring forward the NHS long-term plan pledge to expand community crisis care capacity.

Other government commitments, for example on increasing medical and nursing staff, and the impact of Covid had changed the funding landscape, he argued.

‘There are significant amounts of extra Covid-19 related costs,’ he said. These include rising mental health demand, patients needing extensive and complex Covid-19 related rehab, and ongoing treatment of all patients for as long as we have Covid.’

He added there was significant and understandable pressure to increase staff pay, reflecting public feeling about staff contribution to the Covid response.

‘The core NHS England revenue budget will need to be reviewed to match what the NHS now needs to deliver. The May government settlement is clearly insufficient to meet the long-term plan, backlog clearance and extra ongoing Covid-19 costs. In short, it’s impossible to see how the government can meet manifesto commitments, deliver the long-term plan, deal with Covid-19 impact and recover care backlogs without revisiting/adding to the May government settlement.’

A group of health organisations, the Health for Care Coalition, told the prime minister that the NHS has no hope of clearing the backlog in waiting lists created by the pandemic, unless there is a funded and comprehensive plan to support social care through the coming winter.

The coalition, which is chaired by the NHS Confederation, said social care places were needed to avoid further pressure on A&E departments and ensure patients could be discharged from hospital when appropriate. Social care needed immediate funding to deal with Covid and prepare for winter; a long-term funding settlement; a long-term plan; and a shift to person-focused outcomes-based commissioning.

Confederation chief executive Niall Dickson said: ‘Covid-19 has highlighted the critical role that social care plays in supporting the NHS, but it has also exposed a fractured, understaffed and underfunded system in desperate need of reform.

‘Social care services urgently need immediate funding to deal with the aftermath of the pandemic and to prepare for the possibility of further localised outbreaks, as well as a long-term plan, which successive governments have failed to deliver. Without this, the NHS will be fighting with one hand tied behinds its back. The prime minister has promised to “fix social care”, we now need that promise fulfilled.’