Frontloading of funding is welcome, but there are questions hanging over how we meet the strategic vision set out in the Five Year Forward View

For the NHS, the frontloading of the £3.8bn is good and welcome news, but this money has to be used on genuine service transformation, rather than on filling deficit holes or acting as sticking plasters.

‘As ever, the devil will emerge in the detail’

That brings us on to the strategic question of what we do locally to transform out of hospital care and deliver the vision of the five year forward view.

That said, there are some reservations, including concerns about public health budgets being cut in real terms.

Alongside this, there appears not to be enough in the spending review to successfully address the social care funding gap. It’s not yet clear how proposed measures to plug this gap with the Better Care Fund will work, or impact on the “ringfenced” NHS funding.

Moreover, the evidence is that those local authorities that have had the biggest funding cuts so far are the very local authorities least able to raise funding through their council tax.

Give CCGs some space

Clinical commissioning groups need the space and time to continue working with providers, to develop sustainable out of hospital services, as envisaged in the forward view. Equally, they need to not be distracted by restrictive regulatory approaches or bureaucracy that would dampen CCGs’ enthusiasm to deliver necessary changes for their population.

As ever, the devil will emerge in the detail. The mandate consultation also raises questions about seven day service access and digital roadmaps. The £8bn asked for in the forward view already has to cover many things and the figure was originally predicated on a different set of assumptions. We must review whether those assumptions stand.

We must also ensure that the £3.8bn will be spent on things to deliver a sustainable NHS, as outlined in the forward view, rather than on other priorities.

The promise of £600m investment in mental health does not seem to be additional – but part of the £3.8bn. Of course, we value and support the move to parity of esteem, but if this is another call on the £3.8bn, then it makes the forward view’s ambitions harder to achieve, as well as all of the existing performance expectations.

Julie Wood is chief executive of NHS Clinical Commissioners