HSJ’s weekly email briefing on NHS finances, savings and efforts to get the health service back in the black

What a difference a year makes

Cast your mind back to November last year. Birds were singing in the trees, the sky a clear blue, the country hadn’t voted to Brexit, and the prime minister and Chancellor had a somewhat more positive attitude towards the NHS.

In his spending review speech last autumn, George Osborne said: “The first priority of this government is the first priority of the British people – our National Health Service.”

Yes, the £10bn figure was a fiction from the start; yes there had to be a tough negotiation just to get it front-loaded; yes, public health and social care were still out in the cold; and yes, many knew the deal didn’t really meet the Five Year Forward View’s demands and wasn’t enough to get us through.

Mr Osborne in that speech also pressed the government’s demand for “£22bn of efficiency savings”, but his language implied, to borrow a phrase, that we were all in it together: “We will work with our health professionals to deliver the very best value for that money,” he said.

Fast forward to last week’s autumn statement. The only mention new chancellor Philip Hammond could muster for the NHS was a reminder of that “£10bn of additional funding” – and given that the figure has now been pointedly disavowed, including by the NHS England chief executive, this was more of a threat than reward.

In case anyone still mistakenly thought there might be some lingering Treasury warmth towards the NHS, Mr Hammond, responding to questions, drove his point home – and personalised it: “A senior management team in the NHS has drawn up a plan, set the budget and asked for the money. It has been given the money and I think we should allow it to show what it can do.”

He went on: “We take the view that the NHS has asked for financing of a specific and defined plan. We have provided that financing. We now need to challenge NHS managers who have asked for that money to deliver the outcomes they promised. We will watch very closely and stick close by as they do.”


A first thing to note: Not only is there no more money for the NHS now, but this administration really wants to send the message that there won’t be more soon either. Read Alastair McLellan’s leader for more about the NHS funding game of chicken currently taking place.

Note also: this year the chancellor addressed “NHS managers”, not “healthcare professionals”, and he is both watching you and “sticking close by” – an intimidating prospect at the best of times.

There’s been much Treasury gripping of the NHS behind the scenes already this year, but now there is a very clear and publicly visible hard line from the top. The NHS’s national bosses were more or less let off last year when they all but breached the department’s voted budget. It does not sound like they will be allowed to get away with that happening again.

Finally, note the rapport Mr Stevens had with the previous chancellor and prime minister appears to be gone, and there are reports of a clash between the worldview of the May administration and that of Mr Stevens.

It’s hard not to read Mr Hammond’s comments – particularly the “need to challenge NHS managers who have asked for that money” – as personal to Mr Stevens.