Speaking truth to power and why we will keep pushing for important investment

The Chancellor’s Spending Review last week set out the economic impact of coronavirus. Nonetheless some areas will receive additional investment that we have been lobbying for on your behalf.
 
However, as we said in our media response, it was a bit like putting Polyfilla on a crumbling wall. We are clear that continuing to under-resource the NHS, social care, public health and wider public services will not get us out of the black hole that is the economic forecast.
 
My experience is that we always have to carefully weigh up whether to strongly criticise the government or national leaders. You rightly expect us to influence on your behalf and frankly this is often best achieved without megaphones and in private. There have been times over the years when the Confed’s patient building of relationships and influence has paid dividends. On this issue however, given the mounting pressure on your services and teams, and the very real risk of unrealistic expectations of what can be achieved in the next few years, and while we are still grateful for the modest investment announced, I felt strongly that we had to be clear in setting the strength of our collective concern. This is also important in terms of maintaining pressure for future decisions whether in the early part of 2021 or a longer term plan.
 
We have produced a member briefing which digests the key elements for health and care but to briefly recap: the Spending Review did look more kindly on the NHS than other areas of public spending. It included the much-trailed £3bn to help clear the elective backlog, respond to the rising demand for mental health services and help ease other pressures. There was an additional £500m for mental health services and £260m for staff training and education and some progress on capital funding, which will increase to £9.4bn next year.
 
As I said, we do not want to appear ungrateful: £3bn for the next year, plus the other spending announced, will make a difference, and we are well aware of the context of the state of the economy and the squeeze other areas of the public sector face, not least with regards to the lack of a pay rise.
 
At the same time, political leaders will still need to manage public expectations, and have expectations of you which are fair and realistic.
 
What will also be vitally important for our work is making sure the sector is seen to wring every drop of value we can from the money we do receive, with the crucial first step of ensuring that investment gets to where it is needed most. The Health Foundation’s director of research Anita Charlesworth told our NHS Reset conference this week that one of the most powerful ways of making the case for future funding is to show how well spent the money is. She’s right, and it is incumbent on all of us to do that.
 
None of this push for greater investment is about not taking responsibility ourselves for the challenges we face. We all have to do everything in our power to rise to these challenges and we have seen our members across the NHS doing just that, improving services for their patients and communities.
 
There are lots of great examples such as University Hospitals Birmingham's collaboration with BT to develop a remote diagnostic station, the GRFT programme in London, the way cancer services are being organised in Oxford and Buckinghamshire, partnership working in Wales, the London Ambulance Service paramedics getting on e-bikes to work with PCNs in Merton, the adapted community palliative care service in Liverpool, and so on.
 
Yet we also need to be honest about the limiting factors, which you are only too well aware of – the staff shortages and the toll the pandemic has had on the workforce, the need to fix the social care system, the need for capital investment.
 
We will continue our longer term push to keep the pressure up for investment where it is needed, but also to push for realism about what can be achieved and when, because we believe that’s what our members want.
 
On social care too, we will continue to fight for investment and a long-term plan. You have been consistent about the importance of this issue, and this informs our work including through leading the Health for Care coalition. Indeed, it is one of the reasons we partnered with the Health Foundation for their analysis.
 
We are in a situation now with the national lockdown ending imminently and the introduction of the regional tiers, where the system is being asked to do more and more, and you are telling us clearly how normal services are being hit and COVID-19 pressures are still high. Bearing this in mind, it is good to have money confirmed to support staff, including with PPE and Test and Trace, but we recognise the need to stay close to what happens next as we head into winter and we will press the government to revise its restrictions if the evidence shows they are not protecting the NHS sufficiently.
 
Looking to the future
 
Last week, we also finally saw NHS England and NHS Improvement’s vision for the future of system working. We had published a document setting out members' views the week before and have published a member briefing to help you digest it. We will be engaging with all parts of our membership in the coming month to ensure that your views are reflected in our response to the proposals made by NHS England.
 
In the coming months, we will be refining and improving our offer to all of our members. In order to do that, we believe we need to make some changes to our governance structure. It will help us streamline decision making processes and be more agile. Shortly we will be inviting members to vote on these changes at our AGM, which will take place in February. You can find out more here.

Danny Mortimer is chief executive of the NHS Confederation. Follow him on them on Twitter @NHSE_Danny