Spending Review is an opportunity to invest in the NHS for the future

This autumn, the government will set out its first Comprehensive Spending Review since 2015. As the first long-term funding settlement since Brexit and the onset of the pandemic, this is a clear opportunity to set the health service on a sustainable path.

Public sentiment towards the NHS over the pandemic has in general been very positive, and the government now has an opportunity to reflect that in the Spending Review, as a way to show its gratitude for the incredible efforts the health service has made to keep caring for our communities.

We cannot escape the fact that there is immense pressure on the whole health service, from primary to acute care, mental health to community services. Health leaders describe the present situation as feeling like 'winter in summer' – the demand on the service has been as bad in July and into August as it is in the middle of winter.

New costs

There must be sufficient investment in the health service to help ease some of this strain, so that it can cope with the financial burden created by the pandemic. COVID-19 has brought with it a host of new costs – such as the vaccination programme, the test and trace system, and rising numbers of patients with long COVID – as well as exacerbating existing issues. Many of these costs will be with us for some time.

This is alongside the rapidly growing elective backlog, with a waiting list of 5.5 million people and counting, the rising toll on mental health, and the harsh spotlight that has been cast on health inequalities, especially for people from black and minority ethnic backgrounds and people living in more deprived areas.

Investment can provide major dividends, from reduced inpatient stays through investment in the discharge-to-assess programme, to earlier diagnosis and intervention

Improving economic prospects is one way to help cut health inequalities. This means the government’s 'levelling up' agenda must focus on areas that have been left behind. Deprivation begets worse health outcomes beget deprivation, and so on, especially as people are left unable to work because of untreated or long-term illnesses. This cycle must be broken.  

Investment can provide major dividends, from reduced inpatient stays through investment in the discharge-to-assess programme, to earlier diagnosis and intervention with funding for advances in digital and biotech. In turn, this could lead to better, less resource-intensive interventions. But we need to invest to reap those benefits.

Future funding

Shrinking this backlog will be a monumental task, and will take years of sustained funding and political commitment

Importantly, the NHS needs clarity on future funding, so that organisations can plan services long-term. History has shown that the health service has the ability to cut waiting lists, but shrinking this backlog will be a monumental task, and will take years of sustained funding and political commitment.

However, this isn’t just about hospital care. Beyond the planned construction of 40 hospitals, the NHS lacks a multi-year capital funding settlement. Trusts struggle to get the capital they need to address growing maintenance backlogs. Without this, health leaders cannot develop the infrastructure to reduce the treatment backlog.

A focus on public health will also be vital to fight pandemics and to help prevent potentially more expensive and complex issues further down the track. Yet, the government has slashed public health spending in recent years, while also launching a risky restructure of public health bodies in the middle of a global pandemic. Public health and primary care can no longer be an afterthought.

Underpinning all of this is the NHS workforce. Our staff are at the heart of everything the NHS does, and new hospitals are nothing if we do not have the right staff, with the right training staff, to run them. However, we have yet to see a fully funded, long-term workforce plan for healthcare workers in England.

Alongside this, social care has found itself left out in the cold during the pandemic, bearing much of the burden of illness and death – and yet we are no closer to a long-term funding or policy solution.

Time for an honest revaluation

As we begin to look beyond the pandemic, a new multi-year funding settlement is crucial for both health and care. England went into the CoOVID-19 crisis with less hospital capacity than many similar countries in the OECD and as the pandemic has progressed, a lack of extra capacity had dire consequences. The NHS will need it to help it bounce back. This needs to be built up and sustained during slower periods, so that it’s possible safely to treat more patients during surges in demand.

Now is the moment for an honest revaluation of the long-term funding settlement for the NHS, accepting that this may come at a price, to build in resilience for another 70 years and more.

Matthew Taylor is chief executive of the NHS Confederation. Follow him and the organisation on Twitter @FRSAMatthew @nhsconfed

This blog was first published in The House.