Even as Jeremy Hunt and Philip Hammond argue over the budget boost for the NHS, other people are starting to have some good ideas about helping out the NHS, writes Andy Cowper

Imagine my surprise to find out that on the very same evening that NHS England’s guv’nor, the Sun King of Skipton House Simon Stevens, was  primetime on The One Show, a story was rather flagrantly leaked about a fight between the Treasury’s Munchkin-In-Chief Philip Hammond and health and social care secretary Jeremy Hunt about the budget boost for the NHS.

The article claims that “Hunt is pushing for an increase that would see the NHS budget rise by at least £5.2bn a year, while Hammond’s approach would mean an annual rise of about £3.25bn”.

I’m shocked – shocked – to find that briefing has been going on to push the chancellor into a corner.

Que pasa?

What’s going on here, then?

It’s not wildly complicated. The Treasury Munchkin community is having serious thoughts about giving the NHS less money than it needs again, and watching waiting lists burgeon and genetically alter winter crisis mode into becoming a hardy perennial.

So, the news has to get out. So, someone has to brief it.

Who briefs?

So, who did the briefing deed? Sometimes, it’s one of the main protagonists – but in a story like this, it’s hard to see the benefit to either man.

Philip Hammond is a Treasury minister: he just wishes the NHS would cost a bit less and go away. Jeremy Hunt gets that the NHS needs a significant funding boost, and that an insignificant one will not do. But there are important apple carts not to upset for Mr Hunt: blatantly fighting the Treasury Munchkin Army is not a battle he wants to have in public or in the media.

Mr Hunt has long-term plans – for the NHS, and for his own career. He talked to HSJ about his long-term plans for the NHS.

Mr Hunt’s key points are:

  • The plan should include “full integration of the health and social care system”

  • Over the 10-year plan period, the NHS will need to become “massively more tech-ed up”

  • The plan is likely to identify “really big efficiency improvements” that can be made over 10 years

  • Meeting core performance targets, such as those for waiting in emergency departments and for planned operations, will be an “early milestone” for the NHS in the long-term plan.

Um. It’s an interesting ambition (and Mr Hunt previously offered a 10-year vision back in 2015, in the second HSJ Annual Lecture).

Towards integration

The focus on integration with social care is welcome, if not perhaps new: referendum-prone former prime minister David Cameron promised just such a unification of health and social care back in 2012. We are still waiting: chucking them into the same departmental name is, pro tem, as far as we have got…

There is a meaningful question about whether the NHS is ready for full integration with social care, given that we know that a major problem like delayed transfers of care is complex and not particularly well understood.

Similarly misunderstood are the problems of patient flows through accident and emergency into the rest of the hospital. It might be unkind if accurate to point out that the NHS often tends not to be well integrated with the NHS, let alone with social care.

NHS comes top

Meanwhile, the NHS enjoys top ranking in the latest edition of the long-running Ipsos MORI Issues Index of public concerns, with 46 per cent of survey respondents ranking the NHS as the biggest issue facing Britain today.

This is what’s known in the trade as “not a big surprise”: the recent King’s Fund work looking at NHS resources offers eloquent numerical testimony to the scale and pace of the challenge facing the system.

So, is there hope? Yes, I think there is some. It’s well worth having a look at the recent lecture given by the smart Professor Nick Black, in which he comes perilously close to suggesting that the NHS might want to start paying a bit more attention to culture. It’s always good to see that kind of idea gaining traction. 

And the recent RSA report on health shows that good ideas might be gaining some traction. 

It’s really hard right now, far harder than it should be. But if people are starting to have good ideas, that can only help.