Author: Bev Evans, Jo Andrews, Ben Richardson
Published 17 March 2020

This year’s budget has been more tumultuous than previous years, Chancellor Rishi Sunak only took on the role in February and he has had to deliver a budget in a post-Brexit world and in uncertain times as the coronavirus sweeps the globe.

Mr Sunak gave a compelling speech to the House stating, “We promised to back our NHS – this Budget gets it done.” Over the past five years, the government has injected £34bn into the NHS; the largest investment since the Second World War. The 2020 Budget promises the NHS over £6bn of funding, yet what does this really mean?

Highlights of the 2020 Budget

  • A blank cheque to support the NHS with the outbreak of COVID-19
  • £5.4 billion for day to day spending over four years
  • 50,000 more nurses
  • 50 million more GP surgery appointments
  • Start to build 40 new hospitals
  • Increase community care for people with learning disabilities or autism
  • Free hospital car parking for certain population segments

COVID-19

Mr Sunak has promised the NHS ‘whatever it needs’ in terms of funding which includes a £5 billion emergency response fund to support the NHS and other public services. He said: ‘Whatever extra resources our NHS needs to cope with coronavirus it will get…Whether it’s millions of pounds or billions of pounds, whatever it needs, whatever it costs, we stand behind our NHS.’ The emergency response fund has been put in place to treat coronavirus patients, maintain staffing levels, support social care and wider public services which will be affected by the outbreak.

It is unclear how long the outbreak of coronavirus will last and what impact it will have on the NHS in both the short and long term. It is imperative that the NHS is supported both from a financial but also a strategical point of view so that the system can cope with the burgeoning number of cases.

 

Workforce

It has been stated by those within and external to the NHS, that the system is capital-starved, with wide-ranging areas of the NHS requiring additional budget from estates, social care through to workforce.

The promise of retaining and hiring more nurses is of course welcomed, however, the impact will not be seen immediately as the system focuses on training, recruiting, and retaining nurses.

Attracting and retaining doctors and nurses remains a concern as staff face increasing pressure on Primary Care, in part due to a shortage in Social Care provision. A shortfall in staff is compounded by a reluctance of staff to take on additional hours and a lack of staff coming into the system (not helped by the Immigration Health Surcharge is a potential threat to attracting immigrant health and care professionals as financial disincentives are placed on new arrivals to the UK).

One positive change for the NHS has come in the form of amendments to the pension tax rules, which had seen staff previously turning down promotions and additional hours. It is hoped that as the pension rules come into effect that clinicians will be able to realise the financial benefits and once more accept additional clinical work and promotions.

 

How PCN’s & CCG’s need to best use the increase in capital

In 2019, PCN’s (Primary Care Networks) were created, merging GP surgeries and additional Primary Care Services. CCG’s and Directors of PCN’s have been working over the past few months to put into place the facilities required by the local population. In our article, we outlined that there was a clear benefit of utilising a “population health matrix” to better understand the local population and their needs. It is hoped that all PCNs will start to look towards how best to deliver integrated care. If all PCN’s were to better understand the services required as well as the demand of said services and the capacity today and the capacity required then it would be possible to streamline Primary Care Services which is both scalable and flexible but also highly relevant to the demographic and geography.

 

How the budget can be used for estate management and equipment

The budget has increased the Department of Health and Social Care’s capital spending limit by £683 million, to allow NHS trusts to refurbish and maintain their estate. In a recent article, we highlighted the need to not just repair the buildings but to focus on the clinical services required to better serve the local population. The government has promised £100m of funding to develop the proposals for 40 new hospitals which offers an exciting opportunity to create services which are both fit for purpose now and for the future.

 

How can the budget be maximised to deliver the most effective solution for healthcare systems?

In 2018 we worked with the IPPR to understand the future costs of the NHS and this work was key in securing the additional £20.5bn in 2018 to be spent by 2023/24 equating to an annual increase of 3.4%, although it has been recommended that a 4% annual increase may better meet the needs of the healthcare services.

The 2020 budget reinforces the fact that the system needs more capital to not just keep on top of the deficit but to improve the services for all. We continue to conduct and provide analysis to healthcare systems throughout the NHS to determine what budget is required and how best to utilise the budget given. Our consultants are urging systems to look at a whole system approach to be able to help improve performance and deliver more integrated care systems through creating and implementing clinical services strategies modelled on the demand and capacity needs of the location population.

 

What will be needed following on from the crisis?

While the immediate focus is quite rightly on managing Covid-19, this demands the NHS makes an unprecedented shift away from delivering much of its core business. There will be a significant deterioration in outpatient and surgical waiting times – one that our current systems and processes are simply not set up to address. The need to transform planned care will, as a result, be even more pressing – delivering both on the aspirations of the long-term plan around outpatients, and making much better use of theatre capacity. This means both improving throughput and making fuller use of the physical asset in the short to medium term, so that waiting times are reduced. Both these require investment in implementing new ways of working and in a more flexible workforce. we must also assume that the NHS will continue to be challenged by Covid-19 into next winter, and this will need to be factored into any assumptions around future capacity requirements.

One notable finding in our work with the IPPR was the inverse correlation between NHS funding and efficiency. Put bluntly, every time NHS funding increases, efficiency falls, and vice versa. Above all else, this is a cycle we need to break if we are to address effectively the demands on the NHS today and those, we will be left with because of Covid –19.