The must read stories and debate in the NHS

Funding fight

As if choreographed, hours after health secretary Jeremy Hunt opened a can of worms over the funding of an NHS pay increase in Commons health questions on Tuesday morning, the chief executives of NHS England and NHS Improvement appeared for a two-and-a-half-hour question session with the Commons health committee.

Thus far the row over health funding ahead of the November budget has been fairly civilised – the sector perhaps a bit burned by its clashes so far with the May/Hammond administration and choosing to focus mostly on capital funding.

As HSJ has written, though, the question of day to day spending could never be avoided in this autumn’s budget as, without diversion from the current plan, the NHS hurtles towards the bottom of a funding U-bend in which it would receive a cut in per head of population funding in real terms. Even less now the pay cap is off, as Mr Hunt confirmed in Parliament.

Helen Jones, Warrington North MP, asked Mr Hunt whether a rise would be funded by cuts in services. He responded: “That is something I can’t answer right now because the latitude the chancellor has given me in negotiating future pay rises is partly linked to productivity improvements that we will negotiate at the same time. The fact is we do have that flexibility and I hope we can get a win-win.”

That is a very long way short of a “no” – leaving the door wide open for the NHS to, indeed, be required to fund a pay rise with further cuts to services.

Fast forward to this afternoon and Simon Stevens and Jim Mackey were both very clear this could not happen.

Mr Mackey said it “needs to be funded; it’s very hard to imagine how that could be internally financed”. Mr Stevens said similarly: “That does need to be funded.”

Turning to the broader picture, SS said: “Looking forward to the pencilled in funding for the next year and year after. It looks extremely challenging”. If there was no change, it would be “very hard” for the NHS to meet the asks upon it, he said.

The NHS England chief exec added: “We’re spending £23bn a year less on the NHS than if we were spending at Franco-German levels – and there are consequences of that.”

In one of several mentions for HSJ, Mr Stevens was asked about our revelations about the capped expenditure process earlier this year, and the consequences of ongoing funding constraint. The CEP was a result of the NHS trying to live within its voted resources, was his basic message – so it was up to Parliament (rather, the government) to find some more.

And with reference to the autumn budget: “Decisions taken on 22 November will determine the shape of the NHS next year and the year after.”

One victim of funding constraints in the worst hit areas has been mental health funding. Mr Stevens acknowledged, in an exchange with MP and mental health champion Luciana Berger, that some CCGs in a very tight spot were not going to be increasing their mental health spending as a share of their total – that is, as many in the sector thought they were required to do.