ONE: The long-term plan has been drawn-up based on an extra £20.5 billion being given to the NHS – although this sounds a lot, once split over a five year period, it is actually only a rise each year of 3.4%.
Expert consensus, however, is that a rise of at least 4% per year is needed for the next 5 years to maintain the current level of care, and to make meaningful progress on staff shortages, mental health provisions and waiting times, the NHS will need funding growth of around 5% a year over that same period.
TWO: The government has not followed its own advice on how NHS costs are likely to rise. The new settlement is significantly lower than the 4.3% annual growth in the Office for Budget Responsibility’s projection of future cost pressures due to rising demand. This is an estimate that the IFS, think tanks and most economists agree is a fair measure of how much money the NHS needs just to keep up with demand, let alone improve standards.
THREE: The long-term plan fails to confront the need to raise the basic capacity of the NHS.
There has been no extra funding for the cost of new buildings. An estimated £10bn worth of capital investment in community healthcare is needed to help relieve the pressure on hospitals.
Seven years of underfunding has left the UK unprepared for rising demand with below average numbers of doctors, nurses, hospital beds, MRI machines, and CT scanners per head.
There is a now large mismatch between the capacity of the service and the health needs of our society. In terms of staff, the NHS needs an extra 100,000 staff and funding is needed to recruit, train and retain these staff
FOUR: The long-term plan has a focus on prevention and improving health to reduce demand on the NHS, but some key areas like public health services, are not included in the funding settlement.
Indeed, public health was not just excluded from the funding – even though it provides services that can prevent ill health and reduce future spending, this area continues to experience severe cuts to funding by cash-strapped councils.
FIVE: Pressure on social care is leading more patients into the healthcare system and meaning that some get stuck in hospital. An announcement from the government and a Green Paper are expected, but many previous reviews have already taken place, meanwhile lack of funding and declining care options has led to 25% less people accessing adult social care.
What are the commentators saying about the mismatch between the long-term plan and its funding:
Dame Donna Kinnair, Acting Royal College of Nursing (RCN) Chief Executive, said: “the NHS’s biggest asset is its staff. It is strange then that this plan offers no money for nurses to develop the specialist skills patients need. ”
The Royal College of Midwives (RCM) noted the issue of a lack of funding and a lack of staff. Gill Walton, RCM chief executive said: “The issue of funding services also rears its head. There are some commitments in the plan to postnatal care yet this is an area that has long been underfunded. Key elements of the plan also talk about prevention of poor health such as reducing the numbers of people smoking. But we are seeing budgets for public health services such as smoking cessation cut. It is therefore vitally important that sufficient funding is made available and that we have the right numbers of midwives and other staff in place.”
Chair of the British Medical Association (BMA), Dr Chaand Nagpaul, noted in a statement the lack of detail on how the aims of the plan were going to be realised and the lack of sufficient funds: “Given that there are 100,000 staff vacancies within the NHS, the long-term sustainability of the NHS requires a robust workforce plan that addresses the reality of the staffing crisis across primary, secondary and community care. This will require additional resources for training, funding for which has not been mentioned in the long-term plan.”
UNISON head of health Sara Gorton said: “The plan is honest about the scale of the staffing challenge. But nothing will happen without more money to attract new recruits and train existing employees. The government must act now, or its plan will fall at the first hurdle.”
Unite national officer for health Colenzo Jarrett-Thorpe said: “This new cash is, in reality, putting in the funding that the government removed a decade ago. ‘Smoke and mirrors’ is the name of the game. The money that is now coming on stream is not enough to meet the ambitious targets to save the almost 500,000 lives outlined in the long term plan….The NHS requires an immediate cash injection to meet increasing demand. That’s the grim reality.”
The Health Foundation notes that “without a solution to the growing crisis in social care, people will continue to suffer, and more pressure will be piled on the NHS. Without additional funding for public health, which runs services that are essential for keeping people healthy and reducing health inequalities, NHS plans in these areas risk stalling. The Health Foundation has calculated that an additional £3.2bn a year is required to reverse the impact of cuts to the public health grant and ensure that it is re-allocated according to need.”
“The goals of this plan look right…..what worries me is how difficult it will be to roll out such wide ranging changes. There are several big pitfalls ahead. The extra funding will actually be below the historic average and what experts thought was needed. It’s enough to move forwards, but with little room for manoeuvre. If we face a no deal Brexit, the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks.
“The last few years have seen repeated cuts to public health and social care. The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again. If this goes on, the NHS will be stretched still further as it looks after more people who couldn’t find the help they needed……The biggest obstacle of all is the lack of key staff. Our calculations with The King’s Fund and Health Foundation show a shortfall of 250,000 by 2030, which would make delivering even current services near impossible.”