The American author and campaigner James Baldwin once said that people are “capable of bearing a great burden, once they discover that the burden is reality and arrive where reality is”.
I was reminded of this quote after NHS England published its letter to NHS leaders, which sets out how the health service should address the significant financial challenges they now face.
Industrial action has led to unavoidable financial costs considerably in excess of £1 billion, with an equivalent loss of elective activity. And that’s on top of other unexpected cost pressures from higher-than-predicted inflation.
Health systems and NHS trusts face very hard choices. In far too many areas we will not be able to give patients and the public the level of service they want and deserve. As this week’s performance stats show, particularly when it comes to ambulance services experiencing their busiest month this year for category 1 and category 2 callouts, we are seeing a health and care system that is under extreme pressure. But, as Baldwin says, making choices is even harder if we cannot face up to reality.
...commitments that were already extremely challenging have now become virtually impossible
In the face of the government’s deeply disappointing unwillingness to address the funding crisis, many NHS leaders are expected to achieve financial targets and performance levels that go beyond the ambitious and into the realms of fantasy.
In my conference speech at ConfedExpo back in June, I shared the worry of many of our members that they were being encouraged to over-promise. But commitments that were already extremely challenging have now become virtually impossible. What we did not know back in early summer was that industrial action would remain unresolved almost six months later.
So, where do we go from here?
Firstly, leaders will closely examine NHS England’s letter, which sets out a revised set of priorities for the remainder of the financial year: to achieve financial balance, protect patient safety and prioritise emergency performance and capacity, while protecting urgent care, high-priority elective and cancer care. Local systems have been asked to complete a ‘rapid two-week exercise’ to agree actions required to deliver the priorities for the remainder of the financial year.
This is sensible but it still forces local NHS leaders to make more hard choices and trade-offs about the areas of patient care to deprioritise. This comes against the backdrop of many trust leaders being required to take more than 5 per cent out of their underlying costs this year, with suggestions for many that this efficiency target could increase to 6.5 per cent and above next year.
...it’s now surely inevitable that the Prime Minister’s pledge – one of his top five commitments to the country – to reduce waiting lists will have to be abandoned
Experts in NHS management tend to agree that any efficiency targets over 3.5 per cent stretches credibility. And, lest we forget, integrated care systems, which are expected to coordinate a response to the NHSE letter, are themselves in the midst of taking an eye watering 30 per cent from their running costs.
This week’s developments mean it’s now surely inevitable that the Prime Minister’s pledge – one of his top five commitments to the country – to reduce waiting lists will have to be abandoned. And let’s not forget the impact that long waits and other gaps in health and care provision have on our economy, on patients and communities.
But perhaps the most dispiriting aspect of this week’s developments is that it again underlines the short sightedness of policymaking. On the one hand, ministers rightly push for the service to be more efficient and productive, and for it to embrace new technology and ways of working to get more bang from every NHS pound spent. But on the other, as we have seen in this latest development, every time we face a financial crisis ministers often target capital, technology and other budgets that are exactly the same areas of investment that we need to make the health service more efficient.
...if what we have heard this week really is the last word on central funding then it is our duty to explain to the politicians and more importantly the public what this is likely to mean
There is a long history in the NHS of government’s raiding capital budgets to plug gaps in day-to-day spending, but everyone knows this is counter-productive and merely stores up problems for the future. We must break this cycle if we are going to put the NHS on a more sustainable footing.
It was assumed this week’s funding announcement would pre-empt any additional funds in the Autumn Statement. But we in the NHS Confederation will continue to press the government to use that statement to face reality and allow the NHS to have a chance of getting through winter while making inroads in backlogs.
After all, most of the extra money promised this week was simply a reannouncement of the funds pledged by the Prime Minister several weeks ago. But if what we have heard this week really is the last word on central funding then it is our duty to explain to the politicians and more importantly the public what this is likely to mean.
For as James Baldwin also said, “not everything that is faced can be changed, but nothing can be changed until it is faced.”
Matthew Taylor is chief executive of the NHS Confederation. You can follow Matthew on Twitter @ConfedMatthew