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The NHS Long Term Plan: Our View

Today the government will unveil its long-term plan for the future funding of the NHS. The 10-year plan will see a real-term increase in funding of 3.5% going toward frontline services. A third of the funding increase – which will amount to an annual budgetary increase of £20bn up to the year 2023 – will be dedicated to increased funds for general practice, mental health and community care. With £2.3bn extra going to mental health services whilst general practice and community care will receive a combined increase of £4.5bn.

The National Health Action Party welcomes the additional funding that the long-term plan will bring to the health service. However, we also believe that far more needs to be done in order to secure the financial well-being of the health service for the years to come and to reverse the damage caused by nearly a decade of austerity.

The Economics

All independent experts including the Kings Fund, the Nuffield Trust, Health Foundation and the Institute for Fiscal Studies agree that the health service urgently requires a year-on-year funding increase of 4% in order to cope with current and future levels of demand - the 4% representing the basic minimum by which the NHS can maintain basic functionality. Yet the government’s package falls far short of this.

The package has also been accompanied by a set of stipulations requiring NHS Trusts to sell-off their “surplus” land in order to reduce and/or close their financial deficits. The National Health Action Party has previously pointed out that this is a dangerous phenomenon insofar as it can encourage Trusts to undermine their future capacity for growth in order to cope with immediate financial pressures.

There have also been recorded instances of Trusts deeming land to be “surplus” whilst using said land for clinical practice. The stipulations, as set out in a document entitled Preparing for 2019/20 Operational Planning and Contracting, also state that Trusts will have a duty maximise the amount of income they receive from the private/commercial sector.

Under the plans NHS England will set a benchmark per NHS Trust requiring Trusts to raise a certain amount of its income through commercial activity. This is the first time that NHS England has explicitly required and forced Trusts to raise a determinate amount of their income through commercial practices. One of these practices being to charge patients for treatments (“overseas visitor cost recovery”). In the context of the government’s continued push for greater privatisation of the health service this is yet another worrying development.

Social Care

The health service’s performance is inextricably linked with that of the social care system. As our population continues to age it is vital, we have a social care system fit for purpose. Yet adult social care has been subject to a devastating cut of £7bn since 2010.

Recently the government has made a number of announcements for increased social care funding. Yet in reality these have amounted to one off emergency packages which come no where near to meeting the needs of the system.

The government promised a green paper in 2017 on future long-term funding for adult social care. Yet this still has not happened. Meaning that any extra-funds directed towards frontline NHS care are likely to be undermined by increased pressure coming from the social care system. The most visible symptom being the blocking of beds by elderly patients during winter time who are unable to be discharged.

Public Health and Staff Training

Public health initiatives are essential tools in driving down demand placed upon the health service by preventable diseases and illnesses. Currently, NHS Trusts are experiencing unparalleled levels of demand whilst failing to meet key A&E and cancer treatment targets. At the same time, the waiting list for elective surgery is at its longest since records began. Yet the government’s plan will still see no funding going towards public health initiatives promoting smoking cessation, healthy diet and weight management. Once inflation is taken into account next year will see councils across England cut public health funding by a further 4% as a result of ongoing austerity.

The health service is also experiencing acute shortages in staffing levels. There are number of reasons for the current recruitment and retention crisis. One undeniable factor in the recruitment and retention crisis – especially in professions such as nursing – has been Brexit. With the Royal College of Nursing reporting that Brexit was the top cited reason for EU nurses leaving the UK. The current political impasse over Brexit and continued uncertainty about the UKs future relationship with the EU means that the UK will have to rethink how it can attract either EU nurses/staff or staff from outside the EU to plug the current staffing gaps.

Austerity, increased demand and staff burnout is another core factor of the current crisis. Only recently the Royal College of General Practitioners reported that a third of GPs polled in a survey expressed their intention to leave the health service within the next five years due to feeling stressed and overworked. This comes at a time when the government has pledged to recruit 5000 extra GPs by 2020 whilst actually presiding over a total decline in the numbers of GPs in general practice.

A welcome increase: but it is not enough

The National Health Action Party welcomes the fact that the government has committed to providing frontline services with extra funds. Yet we cannot ignore the fact that the amount set aside simply is not enough and that the government must do much more in order to relieve pressures on the NHS.

This would include a yearly increase above 4% for overall NHS funding. Greater steps towards resolving the recruitment and retention crisis including a stoppage of Brexit and the reinstatement of student bursaries and implementing a new funding settlement for social care.

Ends

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