‘Hear me when I say this – no more money without reform.’ That was the Prime Minister’s message to the NHS only in September, when he promised the biggest reform of the health service since its founding.
But that’s not quite how it has panned out. Labour’s first Budget, which raised an additional £40 billion in tax, also announced an additional £22 billion for day-to-day spending within the NHS. Having allocated more than half of the tax rises to the health service, the promise from Keir Starmer and Rachel Reeves was that improvements would be forthcoming. It’s not obvious, however, that the NHS agrees.
There is never a circumstance where enough resources have been allocated for the NHS to exist in any state but a crisis
The front page of today’s Times is a briefing – or warning – from NHS officials to the Labour party. Starmer is expected to announce in his ‘plan for change’ on Thursday that the NHS will finally meet its target of carrying out 92 per cent of operations within 18 weeks. This is not a new target, but an outstanding one which has not been met for nearly a decade. Yet the response from the NHS, tasked with finally having to meet this target by the end of this Parliament, is not an enthusiastic one. Instead, NHS England is suggesting that meeting the target for routine procedures could turn A&E services into ‘war zones’, while also jeopardising the service’s ability to improve access to mental health treatment.
It’s hardly surprising that this is the NHS’s immediate response. Even when more money has been offered up to the service with clear deliverables attached, the NHS has still gone on to downgrade what can be achieved (including the multi-billion pound top-up to address the post-Covid waiting lists). There is never a circumstance where enough – or more than enough – resources have been allocated for the NHS to exist in any state but a crisis.
The growing problem for the health service, however, is that the numbers tell a different story. NHS spending is at its highest level on record (minus pandemic spending), now sitting comfortably in the top third healthcare budgets across the OECD. And while staff and money has increased dramatically since the pandemic, productivity within the NHS is still well below 2019 levels.
It is increasingly clear that the NHS is doing less with a lot more resources at its disposal: and that was true even before this £22 billion cash injection. But while the optics are a growing problem for the health service, coming up with a plan for reform remains perhaps the biggest challenge facing this new government (details of which we are expecting to hear in spring next year from the Health Secretary Wes Streeting).
The early pay-out has made the process much harder. Having made £22 billion the baseline payment, with no strings attached, what is the NHS going to demand to reach its outstanding targets, or to make serious changes to the way the service runs? What will the price tag be for extended hours, which is part of the government’s reform agenda – and what happens when there are first attempts to bring pay in line with the new league tables recently announced by Streeting?
It’s notable that the Prime Minister’s reset speech this week is going to announce an NHS ambition that is already on the books, albeit not being met. This might be an early indicator that the government is already scaling back its ambition for reform – not because of public appetite, but because of the hurdles that exist with the system. Waiting over four months for routine treatment – especially if a patient is experiencing pain – is not exactly how many would define world-class access to care.
But even this will be very difficult. Having done exactly the opposite of what was pledged – handing over billions without plans for reform – the scale of the challenge has become immensely greater.
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