The must-read stories and debate in health policy and leadership.

A Rubicon uncrossed

In the wake of Theresa May’s announcement that she would increase NHS funding by £20bn over the next five years, there was much comment that a Rubicon had been crossed – as there was no way the government could find that kind of cash without raising taxes.

Endless opinion polls were produced showing the British people would welcome such a move and there was a sense of an argument finally won.

But in the end, the £20bn was funded through a windfall provided by a surprise increase in government revenue, and tax remained (effectively) unraised.

That does not mean that Number 10 (if not the Treasury) had not accepted the need for NHS tax rises – there was plenty of evidence that it had. The revenue windfall allowed them to dodge that bullet.

Hindsight is a wonderful thing, but Simon Stevens and Jeremy Hunt would be forgiven for thinking: “Bugger, should have argued harder for more.”

In other health and social care news from Monday’s Budget:

  • Further PFI and PF2 deals were ruled out by the chancellor, who stated there was “compelling evidence” the deals did not deliver good value for taxpayers or genuinely transfer risk to the private sector. However, the chancellor said he remains committed to the use of public-private partnerships where they deliver good value, so the end of PFI/PF2 does not mean the end of private investment in NHS estates.
  • A new central team to try to cut costs on existing PFI contracts, starting with the NHS, is also promised.
  • Mental health spending will increase as a share of total NHS spending over five years, the Budget document states. Media pre-briefings perhaps undersold this, by saying mental health spend would grow by “at least £2bn” a year in real terms by 2023-24. The £2bn sum implies only that mental health would get similar growth to the NHS budget overall – not quite the increased share of the pie that some think is due. Either way, the clear message is that mental health will be a priority in the NHS long term plan, as expected.
  • The NHS is expected to deliver cash releasing productivity growth of at least 1.1 per cent per year, with a final number to be confirmed in the long term plan. This is higher than the 0.8 per cent delivered over the last two decades, but lower than the 1.4-1.8 per cent the Treasury was thought to be pushing for.
  • The Budget documents confirm the £6bn cash uplift for NHS England spending next financial year, as was announced in June. But they also strongly suggest there will be no concomitant uplift for health budgets which fall outside the NHS England ringfence in 2019-20. This has been the policy of recent years, which has seen capital, training and public budgets cut away.
  • Departmental budgets for 2020-21 and beyond are still up for grabs, though, meaning negotiation will continue over these all important spending categories in the run up to next year’s government spending review. The Budget document said: “The government will consider proposals from the NHS for a multiyear capital plan to support transformation, and a multiyear funding plan for clinical training places. The government will also ensure that public health services help people live longer healthier lives. Budgets in these areas will be confirmed at spending review 2019.”
  • On social care, an additional £650m was allocated to local government in 2019-20. The chancellor also confirmed that the much delayed social care green paper would be published soon, and set out difficult funding choices for the future (not actually make the choices, of course).

In the eye of the beholder

Interpreting incident reporting data from the NHS is as much an art as it is a science. The latest report on the six months from October 2017 to March 2018 from NHS Improvement shows the level of incidents reported during the most recent winter period and it contained some interesting results.

According to the data, ambulance trusts experienced a 33 per cent increase in incidents compared to the same six month period in 2016-17. East of England Ambulance Service, which has been embroiled in multiple allegations of poor care and ambulance delays, made up the lion’s share of reported incidents.

But, as always, there are significant caveats with the data. Higher reporting could simply reflect a better culture among staff who are keen to report incidents to improve learning. Many ambulance trusts say they have improved their systems and processes to encourage more reporting.

However, a 33 per cent increase in a single year is significant enough to warrant highlighting – as NHSI did in its own commentary on the data.

The regulator was quick to say it would be misleading for HSJ to include the year on year comparison, pointing out data from 2015-16 was higher than in 2017-18.

But, if it is misleading, then why did NHSI’s own report do exactly that?

As always, incident reporting, like mortality statistics, need to be taken with a heavy dose of context and nuance that isn’t readily available in the data set.

But where there are sudden changes in the data, it rightly deserves attention, and for service leaders to look at the care they are providing to assure themselves it is high quality and safe.