The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

With any funding increase for the NHS must come the obligatory promise to spend the money on front line staff, while clamping down on bureaucracy and senior level pay.

The Daily Telegraph, typically the most hawkish newspaper when it comes to the health service, had already teed things up with a familiar refrain – that “nearly half of all NHS staff have no medical qualifications”.

Rather than inform readers of the mundane fact that this had been the case for decades, it sought to justify the story with figures saying the proportion of the total workforce who are “professionally trained” clinical staff had fallen from 55 per cent in 2013 to 52 per cent currently.

What this ignored was the rise in non-professionally trained patient-facing staff, such as healthcare assistants, over the last decade, which has [controversially] helped the NHS save money and plug holes in the nursing workforce.

Once these nursing support staff are included in the count, the proportion of the total workforce made up by clinicians and frontline care staff has remained about the same.

But never mind that detail. A few days later the paper was appeased by an exclusive briefing from Stephen Barclay, the chief secretary Treasury, claiming there would be an “audit of NHS jobs” which could lead to a thinning out of highly paid posts in the health service.

The paper said the audit would cover all departments, but the focus was squarely on the NHS in light of the recent funding increases.

The Telegraph continued: “A particular focus for Mr Barclay is the thousands of staff in the Department of Health and National Health Service, which last week put out job adverts for 42 new executives on salaries of up to £270,000, who share the same roles.

“One focus is overlap of roles at NHSX, a body run by the Department of Health and NHS England, and NHS Digital, a non-departmental government body that ministers believe carries out similar work.

“Officials have asked for a breakdown of roles below deputy director level so Treasury officials can evaluate each team, how much it costs and their roles.”

The real difficulty

While backbenchers can be fobbed off with newspaper briefings in the short-term, the real difficulty for the government will be to show voters the new funding, and the substantial taxes raised, are all worth it.

In a piece for Prospect magazine, the Health Foundation’s Anita Charlesworth warned of a “very real risk that come the next general election the public will see the extra national insurance [tax] leaving their wage packet, but they won’t yet see an NHS and social care system which is able to provide what they and their families need”.

She explained: “As part of the new settlement, the government has set aside £10bn to deal with the backlog of planned care. That isn’t enough, and so waiting lists are likely to be higher in 2024-2025 than today—significantly longer than the 18-week waiting time standard.”

Similarly on social care, she says the £5.4bn of additional funding “will not ensure services are available to more of those who need them, it won’t keep up with population ageing, support improvements to the quality of care, or ensure social care workers’ pay, terms and conditions can improve”.

She added: “As Gordon Brown observed, history suggests that governments which don’t protect the NHS pay a heavy price. Don’t be surprised if before the election the Johnson administration is having to revisit these spending plans.”

‘Turn a deaf ear’

Meanwhile, the coronavirus pandemic has not gone away, and the government’s major set piece last week was the announcement of its plan for the autumn and winter months.

Put simply, it consisted of more of the same under “Plan A”, with some measures reintroduced under a “Plan B” if hospitalisations start to become a major problem.

Telling people to behave more cautiously, using vaccine passports and mandatory face coverings in certain settings and considering asking people to work from home all sound relatively modest to many people, given the potential risks.

But the reaction from some of the media betray just how difficult it’s going to be for Boris Johnson to trigger Plan B, let alone any further measures that might be needed in the event of new variants that can evade the vaccines.

“Surprise! It’s back to panic stations”, was the verdict from the Daily Mail. The paper called on the prime minister to “keep his side of the covid bargain”, insisting the public kept theirs by enduring lockdown without complaint.

The Sun argued that Plan A “looks reasonable”, but said Mr Johnson must avoid Plan B “at all costs”. It urged him to “hold his nerve” and “turn a deaf ear” to those clamouring for restrictions at the first hint of trouble.

That might have to mean turning a deaf ear to Sir Patrick Vallance, the government’s chief scientific advisor, who had warned in the press conference: “If this goes in the wrong direction, you need to go earlier and harder than you think you want to.”