HFMA 2018: challenge remains despite funding increase

This was the summary of Health Foundation director of research and economics Anita Charlesworth in a short presentation to the HFMA annual conference.

She said the new money was very welcome but needed to be seen in the context of previous settlements. ‘Since the NHS was founded, funding has grown on average by 3.7% above inflation. The reason things are so tough is because since 2009 the rate of funding growth has slowed dramatically – 1.1% a year under the coalition, 2.3% a year under the Conservative government,’ she said. ‘[This is] far below the pressures on our system.’

The additional funding was ‘very welcome’ and did represent ‘a major injection of cash’. But while the 3.4% average a year was much better than in recent years, ‘it is still below the historic average’, she said. And the real test was how it matched up against service pressures.

Highlighting joint work by the foundation and the Institute for Fiscal Studies, she said that 3.3% was needed just for the NHS to stand still. Modest improvements would need 4%.

‘So while it is a substantial improvement on what we have seen over the last eight years, we do need to be very realistic about what can be achieved,’ she said.

She stressed some of the specific pressures facing the NHS as the number of over 65s increases by 1.1 million over the next five years. ‘We have talked a lot about the ageing of the population being about to happen, we are now entering the period where it actually does happen,’ she said.

She said this matters because someone over 65 uses on average three times as much healthcare as someone under 65 and the health profile of this group was also changing with multiple long-term conditions becoming increasingly common.

She also highlighted major challenges over workforce. Recent work has suggested that the current 100,000 vacancies could grow to 250,000 by 2030 – or in certain conditions even as high as 350,000.

She suggested that the long-term plan being developed by system leaders needed to be clear about priorities and should fast-track new models of care.