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Is Spreadsheet Phil listening? The £350m question

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LGC’s essential daily commentary 

Simon Stevens’ decision this week to resurrect the Vote Leave bus and its promise of £350m a week for the NHS does not bode well for the prospects of health and social care in this month’s Budget.

The NHS England chief executive told a conference of senior health service provider managers yesterday that ministers should increase NHS spending in line with promises made during the Brexit campaign to avoid betraying voters’ trust. This is unlikely to be viewed as helpful by Philip Hammond, a Remainer who never made or endorsed the mythical figure that even leading Brexit campaigner Nigel Farage has branded a “mistake”.

Mr Stevens’ public comments, heavily trailed in the media for maximum impact, suggested he was not making much headway in private discussions with the Treasury. Indeed, the Guardian reported this morning that the “spectacular” outburst was “borne of frustration that he has been close to frozen out of the pre-Budget discussions with the chancellor and feels he is not getting the chance to make the NHS’s case”.

This is a far cry from the run-up to the last Budget, which was actually only six months ago due to the decision to change the timing of the country’s main ‘fiscal event’. Then, NHS support for calls for more social care funding was vital in the additional £2bn that was made available over the remainder of the decade.

And although adult social care funding has now made it on to the political agenda in its own right, if the NHS is not getting a look in with the chancellor, the chances of him finding the additional £1.3bn the Local Government Association says is required immediately to stabilise the provider market also appear slim. The situation could be made worse following the publication of September’s delayed transfer of care performance earlier today, which will determine whether councils face intervention, including the possible loss of control of their share of the £2bn funding.

In his speech yesterday Mr Stevens also warned that failure to make additional funding available for the NHS could see the waiting lists rise to five million and force the abandonment of plans to improve cancer care and mental health services.

Mr Stevens comments followed a warning earlier this week from three respected health thinktanks – the King’s Fund, Nuffield Trust and the Health Foundation – that the NHS needs £4bn next year alone to keep up with demand and prevent services deteriorating. On social care the thinktanks put the gap at £2.5bn by the end of the decade and warn that without additional funding more and more individuals will be denied the care they need.

It is emotive stuff, but unfortunately emotional responses are not something Spreadsheet Phil is known for.

Perhaps Mr Hammond will be more impressed by the thinktanks’ finding that NHS productivity is improving by 1.7% a year, compared with 0.2% in the wider economy, and their conclusion that it is unrealistic to expect further productivity gains to account for the entire funding gap.

Or maybe the call to reverse planned cuts to public health, described by the thinktanks as a “false economy” which will transfer costs to other parts of the public sector, will prove more compelling. The demand for the forthcoming social care green paper to include “costed options” for a sustainable funding settlement, rather than mere warm words and good intentions, may also appeal to his desire to reduce the budget deficit long term, even if in the short term it could prove politically tricky.

However, it seems unlikely Mr Hammond will adopt any of these sensible suggestions. It also emerged yesterday that it is not just Mr Stevens who is struggling to get heard by the Treasury; Mr Hammond’s cabinet colleague Jeremy Hunt revealed he had “yet to win the argument” for more funding with the Treasury. The health secretary went on to say the chancellor’s position was that any additional funding depended on the wider economic context.

Evidence suggests, for the time being at least, Mr Hammond’s priorities lie firmly elsewhere.

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