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NHS cash cut giving us a ‘bigger hill to climb’ in face of rising demand

The financial challenges facing the NHS over the next five years will be made worse because the Department of Health didn’t meet its funding demands, the chief executive of NHS England told the Health Select Committee.

Simon Stevens said that the NHS would have a “bigger hill to climb” because it hadn’t received the funding it asked for in years two, three and four of the five-year period to 2020. He said that in 2018-19, NHS funding will undergo negative growth at a per person rate.

“For the next three years we didn’t get the funding that was requested... so as a result we’ve got a bigger hill to climb,” said Stevens.

“Given we’ve got an ageing and growing population, if you just look at the population growth - even before you take account of ageing – 2018-19 will be the most pressurised year for us - where we actually will have negative per person NHS funding growth.”

Jeremy Hunt, the health secretary, who also appeared before the committee, defended the DH against charges that it had given misleading information about NHS funding.

The government says it has given the NHS an additional £8bn funding over the next five years, and in an interview with the Manchester Evening News on Monday, Theresa May said: “The government has not just given [Stevens] £8bn extra, we’ve given him £10bn extra.”

However, the committee’s own report found that the true figure was closer to £4.5bn, because the department changed the definition of health spending to apply only to the NHS and did not allow for cuts in areas such as public health.

In addition, the spending covers the year before the five-year spending review period as well as the review period itself.

However, Hunt insisted: “Whether you call it £4.5bn or £10bn, it doesn’t matter. It’s what the NHS said they needed and it’s extra money going to the frontline.”

The health secretary was also asked about the Department of Health’s 2015-16 finances, which only stayed within budget because of an unexpected additional £417m in National Insurance contributions, which the department did not notify the Treasury about.

Hunt said the auditor general had found the finances were “legitimate”, but added: “We accept that there were a number of measures taken that were one-off and not repeatable.”

STPs will take a long time to deliver

Stevens was also asked about the sustainability and transformation plans (STPs). In another Health Committee session, Chris Hopson, the CEO of NHS Providers, said that many STPs have resulted in impossible plans which risk “blowing up”.

However, Stevens said he thought Hopson and his fellow witnesses had been “really asking for” more time to deliver the longer-term plans.

He said STPs around the country were in different stages of readiness.

“Some of them are quite advanced and well-articulated and others will need time, having got their 2017-18 and 2018-19 problems put to bed,” Stevens said, adding that STPs in more challenged areas should focus on solving funding challenges in 2017-18 and 2018-19 and prepare plans for 2019-20 and 2020-21 next year.

Jim Mackey, the chief executive of NHS Improvement, who also appeared in the session, agreed with Stevens that STPs would take time to deliver.

“There’s a huge amount of effort going into long-term sustainability,” he said. “I think this expectation we all get up one day in December and everybody guarantees delivery for the next five, ten, twenty years’ time, it’s more complex than that. It’s an ongoing process.”

In a separate statement yesterday, the British Medical Association (BMA) raised serious concerns with the STP process.

Dr Anthea Mowat, chair of the BMA representative body, said: “In order to maximise the benefits from STPs, the NHS, public health and social care functions need to be adequately resourced.

“The tight timescale to sign off STPs risks decisions being made without full consideration of the implications for patients and for staff, and without proper governance procedures being in place.”

Stevens said a 1% contingency measure was being held in reserve from CCG budgets in case financially sustainable STPs could not be achieved in 2016-17. He said STPs would be scrutinised through existing accountability measures for trusts and CCGs, and through “shared endeavour and collective accountability”.

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