NHS leaders locked in winter funding standoff

A senior trust source familiar with the national level discussions, which took place during the summer, said they were hopeful system level winter plans, including any extra funding allocation, would be finalised “this week or next”.

But an NHS England spokesman told HSJ there was “no extra unallocated national funding” and any additional expenditure by trusts to fund more capacity would “need to be offset by a combination of other local savings or deferring other planned in year national trust investment”.

He added that the national commissioner was planning “focused action” in a fifth of health and wellbeing board areas where the problem of freeing up beds by addressing delayed transfers of care is the most acute.

He said “around 600” beds had been freed up so far in 2017-18 as a result of the government’s £1bn extra investment in social care. System leaders estimate 2,000-3,000 beds could be released by addressing delayed discharges.

The 20 per cent of areas earmarked for focused action accounted for around 75 per cent of the remaining targeted beds to be released, NHS England said.

Although providers and commissioners are yet to agree on where extra funding should come from, both sides believe lobbying the Treasury for new money is not an option because the NHS will be making a significant bid for new funding in the autumn budget, it is understood.

News of the stalemate and prolonged negotiations emerged after NHS Improvement chief executive Jim Mackey called for “urgent” action last week to ensure that there were enough hospital beds available over winter.

Mr Mackey also said the government’s extra investment in social care had failed to reduce the number of delayed discharges. This supported NHS Providers’ position – the body said this week only around a third of NHS systems were reporting direct benefit to delayed discharges from the additional funding given to councils.

Asked about the funding debate, NHS Providers chief executive Chris Hopson said: “We know we will be asking the Treasury for more money as part of the budget, so it would be perfectly logical, given the relatively small size we are talking about for winter, to find it from the existing NHS allocation.

“There’s not much point in the NHS asking the Treasury for a sprat at this point, if it wants to try to catch a bigger mackerel later.”

He added that trusts did not want funding “redirected from other areas vital to winter like primary, community, mental health and ambulance care” but were pushing it come out of NHS England’s “contingencies”.

NHS Providers estimated an additional £350m is required. But Mr Hopson said given the current financial pressures on the system, any extra money is likely to be “a lot less”. He did caveat that even if “relatively small amounts” of funding were made available, trusts “were very nervous” about committing to meeting targets, because there was no guarantee they would be able to recruit the extra staff required to boost services.

NHS England said: “Focused action is now being required in the fifth of health and wellbeing board areas, which account for nearly three quarters of the remaining DTOC improvement needed to meet the national capacity target.

“If in the view of the national emergency care director, Pauline Philip, further capacity is needed in particular locations, since there is no extra unallocated national funding, expenditure at those institutions will need to be offset by a combination of other local savings or deferring other planned in year national trust investment.

“Over and above this, trusts have now reported that within their previously agreed 2017-18 operating budgets they are going to able to fund at least an extra 3,000 beds over the winter period, and fortunately NHS Improvement is reporting combined demand growth in [the first quarter] for emergency and elective admissions has been one third lower than [the] trusts’ own plans.”