We’re told the NHS is protected from cuts — but this alone won’t save it

The triumvirate has spoken — the Prime Minister, the Chancellor and the health secretary have all promised in quick succession that the NHS will be prioritised in the Autumn Statement and beyond. But buyer beware: we have been here before and all may not be as it seems.

As we approach the fiscal statement on November 17, the NHS is looking for certainty that it will get the backing it needs to deal with record waiting lists and the impact of soaring inflation.

The critical first step the government needs to take is to give the NHS an inflation-proofed settlement. This must cover the £7 billion funding gap that is predicted by NHS England for next year alone.

Protecting the whole budget

This also means truly protecting the whole of the NHS budget. Back during the decade of austerity in the 2010s, the then government claimed it protected the NHS budget when it not only gave the NHS its lowest ever real-terms increases, but it also failed to protect vital areas of spending that sit outside of the NHS England ringfence — namely social care, capital investment, public health, and training and education budgets.

If social care reforms are delayed by another year, this will only serve to exacerbate the bottlenecks across local services and harm patients

Alongside this, the government must finally take the action that is so desperately required to address the dearth of adequate social care provision, including introducing a minimum wage for social care staff. Social care is about so much more than alleviating pressure on the NHS, but without action to address the lack of capacity in social care, the NHS will continue to experience huge delays in discharging medically fit patients from hospitals. If the rumours are to be believed and social care reforms are delayed by another year, this will only serve to exacerbate the bottlenecks across local services and harm patients.

The government must also guard against any urge to raid NHS capital budgets to plug holes in day-to-day budgets — another feature of the 2010s. This is a false economy and will not enable local NHS organisations to become more efficient and to deal with lengthening waiting lists, as well as the £10 billion maintenance backlog we now face.

And finally, ministers must recognise that a failure to make any real commitments on or investment in health inequalities and in promoting better public health brings with it another false economy, something that is keeping health leaders awake at night. Various important government white papers and plans, ranging from tackling health inequalities to taking action on tobacco and sugar, have either been dropped or stalled. Failing to act now is simply storing up problems for the future.

A rare consensus

There are reasons to be optimistic that the NHS can pull through the difficult period it now faces, albeit with another perilous winter on the horizon. Importantly, we have a rare consensus on the direction of travel for the NHS that is about empowering local partnerships of health and care organisations — integrated care systems — to address the root causes of illness and health inequalities.

these local partnerships need to be freed from the level of targets, central direction and micromanagement that has dogged the NHS for decades

The government legislated for these new bodies in the summer, but they are yet to create the conditions required for them to fully succeed. Now they are up and running, these local partnerships need to be freed from the level of targets, central direction and micromanagement that has dogged the NHS for decades.

We must start to see fewer, but better focused, national targets. Encouragingly, there are indications that the new administration may feel the same way and that we may start to see a gradual loosening of the centre’s grip, with more control and autonomy handed down to local systems. This is the only logical way to run what is the fifth largest employer in the world.

In return, NHS leaders know there is an important quid pro quo: that they are able to effectively lead and collaborate, reduce unwarranted variation in the care patients receive, deliver savings like never before and embrace digital and other forms of innovation. They will be expected to trim any remaining fat and to ensure they are running as efficiently as they possibly can to deliver for the general public, the taxpayer and to help to close the government’s funding shortfall.

To give the NHS the best possible chance, the government must first get the fundamentals right and that means delivering the resources and support that local NHS leaders need to deliver for their communities. Failure to do so will be akin to giving them only half a lifejacket and expecting them to survive a storm at sea. This cannot be allowed to happen otherwise we will waste this rare consensus.

This article first appeared in The Times Red Box on Monday 7 November.

Matthew Taylor is chief executive of the NHS Confederation. You can follow Matthew on Twitter @FRSAMatthew