Funding key to re-imagined services

by Seamus Ward

29 September 2020

More than 85% of NHS leaders are not confident they can deliver the ambitions of the NHS long-term plan within the revenue settlement, according to the NHS Confederation.

A survey of more than 250 NHS leaders, which was taken in September, also found three-quarters felt they have insufficient capital funding to achieve the plan’s goals. The survey informs a new confederation report, NHS reset: a new direction for health and care.Danny Mortimer

The report calls for a ‘re-imagining’ of the service to ensure it emerges stronger from Covid-19.

It says the pandemic has impacted the ability to deliver services. Almost 90% of leaders said lack of funding will be a significant barrier to achieving the waiting times standard, while nearly three-quarters lacked confidence that the near normal levels of activity aspired to in the NHS phase 3 guidance would be delivered. Fewer than 10% said current funding allowed them to deliver safe and effective services.

In the report, NHS leaders call for extra revenue and capital funding over the next three years to help the service adjust to the impact of Covid-19. A multi-year settlement would give the NHS certainty and the ability to plan its investment in services and equipment.

Bidding, particularly for capital funding, should be simplified, while politicians should be realistic about what the service could achieve. ‘Politicians and national bodies need to support the NHS to manage the realities of recovering services, not set unrealistic targets and impose financial penalties,’ the report said.

Integrated working is an integral part of the long-term plan and has been seen widely during the Covid pandemic. But the NHS leaders told the confederation that a future system working model must be underpinned by a fit-for-purpose financial framework. Commissioners must move away from transactional relationships with providers – as seen in payment by results – towards an approach based on shared incentives, risk sharing and outcomes rather than activity.

As part of the NHS phase 3 response to Covid-19, which will see a focus on restoring services, NHS England and NHS Improvement set out a system-level financial model. The report welcomed this: ‘We welcome that health service finances will be system managed for the remainder of the year and hope that this represents the start of a long-term shift towards increased financial control for systems,’ it said.

Positive developments made as the NHS adapted its services in the face of the pandemic should be kept. These included a reduction in bureaucracy, devolution of powers to local leaders, acceleration of the integration of health and social care, and sustained, funded action to tackle health inequalities highlighted by Covid. More than 80% of leaders told the confederation that the NHS must improve its care for diverse and marginalised communities.

NHS Confederation chief executive Danny Mortimer (pictured) said ministers had to act. ‘This is a moment of truth for the government and its stewardship of the NHS. Either it embraces what we have learnt in recent months and provides the support and investment the NHS and social care need to get back on track and reform for the long term, or it continues with short-term fixes, bail-outs and ever-increasing targets and regulation that continue to stifle NHS staff from locking-in the changes that are essential if the health service is to manage the threat of the pandemic and emerge in a stronger position.

‘In return, taxpayers and the government will rightly expect the NHS to embrace new technology, eliminate waste and deliver services in new and improved ways for patients.’