The King’s Fund has published a nudge (source) to the Chancellor regarding the upcoming spending review .
The Key messages :
- With all parts of the NHS under growing financial pressure, and even the most prestigious and well-run hospitals now forecasting deficits, the NHS is on course to overspend its budget in the current financial year. Emergency deficit funding is likely to be required this year, perhaps amounting to £1 billion.
- The government’s commitment to increase the NHS budget in real terms by £8 billion by 2020 is welcome but this is the absolute minimum requirement to maintain standards of care. It will not pay for new commitments such as seven day services. It is essential that this money is front-loaded from 2016/17 to avoid an accelerating decline in performance and quality.
- A dedicated transformation fund is essential to unlock productivity improvements and support the development of new care models across health and social care. Our work with The Health Foundation estimates that £1.5 – £2.1 billion a year is required from 2016/17 to 2020/21. Some of this funding could be found from existing sources, although additional funding will also be needed.
- The previous government protected all health spending. This approach must be maintained. Further cuts to the public health budget would be a false economy and undermine government commitments on prevention. There are also risks in cutting spending on training the future workforce when staff shortages and the costs of agency staff are major concerns.
- While achieving £22 billion in efficiency savings by 2020 is hugely ambitious, there are significant opportunities to improve productivity, and the NHS must engage staff at all levels in a new mission to deliver better value at lower cost by changing the way that clinical care is delivered (Alderwick et al 2015). The 1.4 million staff who work in the NHS must be supported to achieve this.
- The social care system must be protected from further cuts in local government budgets and the £6 billion in funding previously earmarked to implement the Dilnot reforms must be invested over the Spending Review period to tackle the growing pressures on social care. If this does not happen, publicly funded social care will be become a safety net for only the poorest and most vulnerable members of society.
- The temptation to support social care by transferring funds from the NHS must be avoided. Instead, as the Barker Commission set out, there is a compelling case for a new settlement that brings the two systems together and moves to a single ring-fenced budget and a single local commissioner of services. This is best done by a staged transition over the next decade as outlined by the Commission (Commission on the Future of Health and Social Care in England 2014).
- To ensure adequate funding, the long term aim should be to increase public spending on health and social care to 11–12 per cent of GDP, the proportion currently spent by countries such as France, Canada and the Netherlands on health care alone. On current plans, GDP on health care in 2020/21 will fall back to levels last seen in 2005/6, underlining the seriousness of the situation facing the health and care system