The government should stop sleepwalking into the future and provide the NHS with sustained increases in funding to meet unprecedented demand for care
The NHS has rightly been praised for its response to the pandemic, but risks running into serious trouble unless the government faces up to the scale and depth of the challenges it now faces. In my work I see staff working incredibly hard every day to make inroads into the backlog of unmet need that arose during the pandemic and tackle the pent-up demand that has been released in recent weeks. The worst of covid may be over, at least for the time being, but the consequences for patients with other conditions will be with us for a considerable time.
The ability of the NHS to deal with these consequences is constrained by staff shortages and by the toll taken by the pandemic on staff health and wellbeing. There has been much focus, understandably, on the growing number of people waiting for elective care, but rising use of urgent and emergency care and unprecedented demand for mental health services are just as important. General practices are also struggling to meet increased demand at a time when they are seeing more patients than ever and playing a major part in the vaccination programme.
The government’s response to these challenges has fallen well short of what is needed. Additional funding has been provided for the first half of the current financial year but there is uncertainty about whether this will be extended into the winter months. The longer-term prospects will be determined by the forthcoming spending review when the needs of the NHS will be considered alongside those of education, social care, and other public services.
The underlying financial pressures in the NHS have been masked by the time-limited injection of extra resources by the government to cover the costs of covid. Absent these resources, many organisations would be in deficit at the very time when they should be increasing spending to meet rising demands. Recent warnings by NHS England’s chief financial officer that the NHS should expect normal financial disciplines to return is a clear sign of the Treasury’s thinking. This will expose the reality of sustained underfunding of the NHS during the last decade and the impossibility for many organisations of balancing budgets and improving patient care.
Only a multiyear funding settlement above historic annual increases of around four per cent will come near providing the resources required. Priority claims on these resources include fair increases in pay for staff, adequate funding for the expansion of education and training to build the workforce of the future, continuing investment in elective care to reduce waiting lists and waiting times to acceptable levels, further progress in ensuring parity of esteem for mental health services, the expansion of services for people with long covid, renewed commitment to the health and wellbeing of children and young people, and sustained investment in hard pressed primary care and community health services.
The government must also recognise the claims of social care and public health. This means restoring the public health grant to local authorities to compensate for cuts made in recent years and investing in social care to enable the NHS to focus on the treatment of people with acute medical conditions. An essential step would be to make permanent the additional funding made available to support discharge from hospitals during the pandemic as well as providing councils with resources to enhance preventative services to those most in need.
The pandemic has exposed the urgency of increasing capacity on a permanent basis, particularly in critical care. The heroic actions of clinical teams supported by managers meant that intensive care services were never overwhelmed, but at the peak of the recent surge it was a close-run thing. The government must provide the NHS with the resources to prevent this happening again and ensure that as a country we are much better prepared to respond to future threats on the scale of covid. This requires a commitment to substantial capital spending to tackle capacity shortfalls, make inroads into backlog maintenance, and allow for investment in new equipment and technologies that have the potential to transform care.
A precedent for what is needed can be found in the independent review of future funding needs in the NHS undertaken twenty years ago by Derek Wanless at the request of the then Labour Government. Wanless’s final report, published in 2002, was associated with increases in spending that enabled the NHS to make steady improvements in patient care over a number of years. Today’s challenges require a similar response together with realism about the time it will take to restore and improve services to meet the needs of the population.
In his recent assessment of the Wanless report, Nick Timmins shows that the combined support of the prime minister and chancellor of the exchequer at the time was instrumental in ensuring that its recommendations were acted on and made a difference to patient care. A similar commitment is needed today, encompassing social care as well as the NHS, to create a resilient health and care system. It’s time for the government to stop sleepwalking into the future and face up to the realities many of us encounter each day. Staff and patients deserve nothing less.
Chris Ham is chair of the Coventry and Warwickshire Integrated Care System, non-executive director of the Royal Free London Hospitals NHS Foundation Trust, and co-chair of the NHS Assembly. He writes here in a personal capacity.
Competing interests: none declared.