HSJ’s roundup of the essential stories from a busy week in health policy
1 Simon Stevens still has some political capital
The week began with a genuine surprise to most, when it emerged that – despite fraught spending review negotiations and spiralling financial problems in the NHS – the Treasury had agreed to “frontload” its promised £8bn real terms investment in NHS England to the tune of £3.8bn in 2016-17. The news was seen by most commentators as a relative triumph for the NHS England chief executive, with HSJ editor Alastair McLellan writing: “Before you judge the outcome of the comprehensive spending review, consider this. The Treasury’s opening position was that NHS funding should be backloaded, arguing that the Conservatives’ manifesto commitments were for the end of the parliament.”
2 There won’t be much actual capital knocking around the NHS
Triumph or not, the extra NHS England funding will come partly at the expense of significant cash cuts to the £15.1bn of Department of Health expenditure that sits outside NHS England. As HSJ warned in September, the NHS “ringfence” has been redrawn to exclude health education, public health, capital, and the arm’s length bodies. This pot will shrink to £13.2bn by 2020-21. Public health faces 4 per cent annual real terms cuts, and nursing education will switch to student loan funding. And, as it emerged on Friday, the DH has already agreed a £1.2bn raid on its capital budget in 2016-17, to smooth the impact of what would otherwise be a very large cash cut to its non-NHS England revenue expenditure.
3 We will still be talking about the crisis in social care in five years
George Osborne can argue he has maintained social care funding in real terms by giving local authorities permission to raise council tax by 2 per cent, and ringfencing some existing council grant cash. But this will not keep pace with rising demand for services or fund the increase in the minimum wage which will inflate the cost of providing social care. And what extra funding there is will be backloaded. These combined factors mean the spending review settlement has done little to allay fears that services are at risk of imminent collapse. One shred of good news: at least the NHS’s revenue budget hasn’t been topsliced to fund social care this time, as happened under the better care fund.
4 The DH and junior doctors learn it’s good to talk
Or so the health secretary and British Medical Association have belatedly learned: NHS Employers and junior doctors’ representatives began discussion through mediation service Acas over contract proposals on Thursday morning. This followed months of dispute and comes with the juniors planning their first strike for Tuesday. As this Executive Summary was put to bed, there was no word of a deal being reached, and the facilitated nattering is believed to be ongoing.
5 Power doesn’t switch off
On Monday we learned the 100 people expected to be most influential on the NHS in the next 12 months, with the unveiling of the HSJ 100. Simon Stevens came top, echoing his relative success in the spending review. Ever the workaholic, the NHS England chief exec wasn’t heading to the pub on Friday night, but was due to appear on BBC Radio 4’s Any Questions? programme.