£1.8bn funding boost 'just a down payment'

3 Comments

More than half the £1.8bn spending boost announced by the prime minister yesterday will be enabled by the reversal of last month’s demand from NHS England that trusts cut capital spending plans by 20 per cent.

The remaining £850m has been allocated to 20 specific capital schemes.

HSJ also understands that a separate “technology fund” will be announced later in a week, which is expected to feature a series of government announcements on the NHS.

In July, HSJ reported NHSE finance director Julian Kelly had written to trusts telling them to cut their spending plans because they threatened to bust the Department of Health and Social Care’s capital expenditure limit. A letter in May, which asked for voluntary cuts only, produced a reduction of 3 per cent.

However, HSJ’s sources say the government has agreed to lift the limit, enabling increased expenditure of up to £950m during 2019-20. They said it is hoped that decision would particularly aid financially “liquid FTs” to tackle maintenance backlogs.

Details of the technology fund have not been released. However, HSJ understands that it will initially be focussed on improving the NHS’ diagnostic capacity. The NHS long-term plan highlighted the service’s lack of CT scanners as part of the reason it performed relatively poorly on cancer.

Former Care Quality Commission chief inspector of hospitals Sir Mike Richards told HSJ’s cancer forum in March that the NHS’s diagnostic capacity was “woefully poor” thanks to capital spending restrictions. He is currently undertaking a review of the issue for NHS England.

Commentary: Just a down payment

The first and natural reaction from the service to Mr Johnson’s largesse will be “is that all?”

The list of 20 schemes does not include one costing more than £100m. HSJ’s list of potential candidates, for example, included over a dozen costing above that figure.

It is also the case that half of the “new” money is accounted for funding that trust’s thought they would have access to until Mr Kelly’s unwelcome first letter in May. It is important to stress as well that many of these projects – most of which are designed to tackle maintenance backlogs – have not yet been fully signed off.

So far, so par for the course.

However, it would be foolish not to recognise that the change of prime minister has created an opportunity for the NHS.

Earlier this year, the chief executive of pollsters Ipsos Mori Ben Page told HSJ the best way for a government to improve its standing with the public on the NHS was to shower them with announcements about building things.

Nobody understands that better than the PM’s adviser and Brexit campaign mastermind Dominic Cummings.

National NHS leaders have been told to provide any and all good ideas that can be announced in the “next 100 days”, as the government gears up for a no-deal Brexit and/or a snap general election.

NHS England chief executive Simon Stevens and health and social care secretary Matt Hancock are too sharp to look a gift horse in the mouth.

This is why one of the week’s announcements will, for example, include a revised consultation on doctor’s pensions – the details of which the previous administration would never have stomached.

We will also see short- and longer-term efforts to loosen the Treasury’s grip on capital spending allocations and a concerted campaign to stress how much more capital the NHS needs in the run up to an “emergency budget” during early October.

There was a very good reason that Hillingdon hospital in the PM’s constituency was left off the list of hospital upgrades. The message to the new PM is “thanks for the down payment, but you’ll need to dig a lot deeper to meet your pledge on the side of that bus.”