NHS England boss Sir Simon Stevens’s final speech today was watched online by hundreds of health service bigwigs. But its main audience was much smaller. It was aimed squarely at just two people: Boris Johnson and Rishi Sunak.
Stevens’s main message was about funding. The government, and, in particular, the Treasury, may not be thrilled once they wrap their heads around his statement on the five-million-strong (and Covid-predating) NHS backlog that ‘when the health service is given the backing and the tools we need, we can deliver what’s required’.
Translated into plainer language, Stevens was saying: ‘Get your wallets out: this is going to hurt’. The mega-hint here is clear: Sir Simon is putting the Treasury on notice that he can use his seat in the Lords to be a thorn in the government’s side should they try to short-change the NHS of the funding it badly needs.
Given the NHS’s popularity in the wake of the vaccine triumph, this is something that could come back to bite the government
There is a loud echo here of Stevens’s ‘five tests’ for the 2015 Comprehensive Spending review negotiations. These were ‘front-loaded investment’; ‘new asks from the NHS consistent with phasing of the new investment’; political support for change; protecting social care; and action on public health.
Those five tests gave Stevens a strong negotiating hand with the Cameron-Osborne administration, as it was clear that the government didn’t deliver fully on them in that review, and didn’t deliver at all on the last two. That non-delivery limited the NHS’s room for manoeuvre, but also prevented the government from blaming the NHS for failing to deliver on its targets.
It is obvious that he is lining up a similar pitch this time around. And given the NHS’s popularity in the wake of the vaccine triumph, this is something that could come back to bite the government if it is seen as not giving the health service the resources it requires.
Today, Stevens also fired another costly shot across the Chancellor’s bows about the proposed one per cent pay settlement for NHS staff.
‘Staff in the NHS need fair and appropriate pay: that is a statement of the obvious,’ he said. He also sought to limit the Treasury’s room for re-nationalisation of the extra funds allocated to the NHS for Covid-19 and perhaps not yet spent, observing that this money ‘can potentially be repurposed for some of that catch-up work’ to start clearing the NHS backlog.
Stevens also mentioned social care, but with the demeanour of a man who recognises that this issue is stuck deep in the long grass, and (given the current Treasury-No. 10 wrangling) is apt to stay there.
For now, Boris enjoys a healthy lead in the polls and appears unassailable. But Steven’s veiled warnings on the need to provide for the health service are a reminder to the Prime Minister that things could sour very quickly. The Prime Minister has been quick to thank the NHS for its work in tackling Covid-19. But if he doesn’t put his money where his mouth is, Lord Stevens could soon become a troublesome voice on the red benches in parliament.
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