The must-read stories and debate in health policy and leadership.

The government has spared little opportunity to proudly announce healthcare spending pledges during the pandemic, a clear case of flag waving to show it’s made good on promises to give the NHS “whatever it needs”. What is becoming transparent, however, is how subjectively that “need” was meant to be understood.

There have of course been significant spending pledges on diagnostics, emergency departments and hospital rebuilds. But, even amid a health crisis, the investment and commitment doesn’t seem to ever reach adequacy.

Whether it was the “Seacole” centres that got the chop, or the funding increases in last month’s spending review, it often feels like the investment falls short of resolving the NHS challenges, virus or otherwise.

Even now, following an HSJ investigation, it’s been revealed that hundreds of millions of pounds worth of equipment and facilities requested by trusts in the lead-up to the second wave have not been rubber stamped. Oxygen, modular theatres, critical care equipment and infection control facilities are just some of the claims that gathered dust.

Obviously, forensic scrutiny of healthcare finances is a totem of Managing Public Money. But the understanding that these bids (some of which date back to June) are being assessed “line by line” by the Treasury may bruise somewhat. This alleged scrutiny appears particularly parsimonious when compared to the fair-weather generosity handed out on national contracts for PPE and testing.

One finance director labelled these delays “a national disaster”. Evidently, they appear to have a point. With the trials of winter, a crushing backlog and talk of a third wave of infections perhaps now is the time to stop giving the NHS what it needs and start giving it what it deserves.

Procedures on pause

Keeping electives running has had a high priority in the NHS throughout the second wave – and although some trusts have cancelled non-urgent work, this has been sporadic and often limited to the trusts most severely affected by covid.

So it is a sign of how badly hit Kent and Medway have been that all acute trusts have now “paused” routine electives for the next two weeks at least, according to the area’s clinical commissioning group. Cancer and urgent work will continue but it is likely that thousands of procedures will be affected.

The weeks around Christmas and New Year tend to be quiet anyway so it may well be January before there is significant elective work carried out. By then the effects of relaxing restrictions over Christmas may be becoming clear – and that may not be good news for electives either.

Kent and Medway – where several areas feature in a top 10 of the highest covid rates in the country – must be hoping the second wave has passed through and is blighting somewhere else by then.

Matt’s bard at work

It’s not easy being the health and social care secretary during a pandemic so Matt Hancock can surely be forgiven for a display of laughter on Good Morning Britain. Positively crying with it, in fact. The mirth-inducing topic in question related to the first recipient of the covid vaccine. Name? William Shakespeare.

Some cynics suggested Mr Hancock’s tears of laughter were “fake” but, as HSJ’s reporters lack the diagnostic capacity to assess tears or indeed laughter, we are unable to comment further. Decide for yourself here.