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

Deal or no deal

This week’s NHS Confederation conference was heavy with chatter that a government announcement on a new NHS funding settlement may be imminent, potentially as imminent as this weekend.

The prime minister committed back in March to delivering a “long term” budget deal this year, and if she is to avoid humiliation now needs to announce something fairly weighty by the time of the NHS’s big seven-oh bash on 5 July.

But negotiations, with the need to get a sceptical and stretched Treasury to support decent growth, have been hard work – on Thursday Jeremy Hunt told the conference talks were “difficult and ongoing”.

NHS thinkers have said real terms annual growth of at least 4 per cent is needed, while the chancellor’s starting point was around 2 per cent – HSJ has previously predicted we’d end up with something starting with a three.

The best of the likely possible outcomes for the birthday announcement would be clear and transparent annual growth commitments, close to the upper end of these numbers, and covering the whole of the health budget, for the next few years (social care needs a deal too - but there is now little expectation that is close).

The worst would be no deal at all – perhaps pushing a funding announcement off altogether until November’s Budget.

A middle option fudge of some form is also a real possibility (isn’t it always?). Big numbers may be thrown about to grab headlines but with insufficient detail on the real size of growth; or some kind of holding policy position issued to delay the real decision.

If and when an announcement is made, all eyes will be on whether Simon Stevens says it’s good enough or not; something which might be rather tricky and confusing if a fudge is put forward.


Unless the NHS changes the way it is planning and managing its workforce, it will have a shortfall of 115,000 workers in 10 years’ time according to the head of Health Education England.

Ian Cumming laid out the challenges facing the NHS in a stark presentation that also showed an additional 16,000 full time equivalent nurses have left the NHS due to higher turnover rates in 2017 than in 2012.

He also set out how 40 per cent of doctors who qualified as GPs five years ago are not substantively employed in the NHS.

But he had some small crumbs of comfort. The Continuing Professional Development budget is being boosted by 17 per cent this year and HEE is now planning to meet its GP trainee target for the first time ever this year.

Professor Cumming was clear that current projections show the NHS will not produce the numbers of staff needed.

We will have to wait a few more months for the workforce strategy to offer any solutions.

But, then we have been waiting for solutions since HEE was created.

His warning came after some better news leaked out of the government (see below)

Javid turnaround

NHS leaders around the country may well have breathed a sigh of relief following reports that the Home Office is relaxing restrictions on the number of tier two visas issued to non-EU skilled workers.

For the past six months, thousands of visa applications have been turned down by the Home Office, as doctors and nurses are not only competing against each other but also against other skilled workers for the limited number of visas.

NHS Employers, the British Medical Association and various Royal Colleges have all spoken out about the cap and called for action from the government, making clear that the cap is affecting patient safety and causing severe rota gaps.

Home secretary Sajid Javid has listened to these calls and this represents his first major policy change since taking on the role.

However, as raised by NHS Providers, scrapping the cap is a step in the right direction but certainly not an end to the NHS workforce crisis.