Many in the NHS believe that a bailout is just one or two scandals away – it is a dangerous assumption, writes Alastair McLellan

In the wake of last week’s autumn statement, Theresa May’s government and the NHS are locked in a standoff over funding.

At a recent meeting, a senior healthcare figure told the prime minister that she would, like all recent governments, eventually give in to the sector’s pleas for more cash. The reply clearly indicated the lady is not for turning.

In this game of financial chicken many in the NHS believe they have time on their side, that a bailout is just one or two scandals away. It is a dangerous assumption.

This government is putting its weight behind landing Brexit, hopefully dealing with the electorate’s concerns over immigration in the process, and keeping the economy from tanking.

It reckons this offers a better chance of electoral success than sending more cash the way of the NHS. It is acutely aware that investments in the NHS have often not demonstrated a clear return nor quietened the service’s demands for more resources.

The hard-headed political calculation includes the observation that Labour’s ceaseless campaigning on the NHS does not appear to be increasing support outside its core vote, and that after six years of austerity the public’s concern, though rising, does not match lobbyists’ sense of “crisis”.

Late last week horrific failings in the maternity department at Pennine Acute were finally made public. In the recent past the tabloids would have blared “left to die alone” from their front pages, but after a brief flurry of interest the news caravan moved on. A recent conversation between half a dozen of health’s most experienced policy figures tried to conceive of a “shock” big enough to make the government think again on NHS finances; they failed.

The NHS now faces a hard choice. It can indulge in a crescendo of virtue signalling, with various interests attempting to outdo each other in depictions of impending doom, the size of investment needed to deal with it and/or the number of celebrity endorsements.

This is unlikely to work.

At the very least the constant cries that the wolf is at the door in a situation where the service is still providing quality care in most cases undermines credibility. The most immediate consequence will be for those in government to question the competence of those charged with leading the service.

This approach also tends to infect local plans with a taint of a national “emergency” in which every service redesign, however appropriate or carefully consulted on, is seen as part of central plan to save money.

So what might work?

Well, turning down the volume looks a good tactic. This is a government (unlike Cameron’s) not fond of U-turns and likely to dig itself in further under sustained attack.

Better to offer innovative ideas how social care delivery might be reformed as well as better funded. There is real work going on at the highest levels of government here, a fact which the “missed opportunity” reactions to the autumn statement themselves failed to spot, and these discussions provide a real chance to influence the outcome.

Alongside this a focus on improvements in care and efficiency would also help build confidence.

This will be key as the 2017 Budget (now moved to the autumn) approaches. A “70th birthday present” to the service is much more likely to get the go-ahead compared to a grudging surrender to howls for more cash.

Finally, there is mental health – the one area where there are signs of improved funding and another with interest from the top of the office.  

All of this may seem unfair, even disingenuous in not shouting from the rooftops about the danger the NHS faces. But, as the last PM to properly fund the NHS said, “What matters is what works.”