Unfinished business - let's not forget the Spending Review and the vital funding needed for the NHS

Niall Dickson and Jennifer Dixon

The 70th birthday settlement was a welcome boost for the NHS, but the government mustn’t lose sight of the fact the Spending Review must provide funding if the NHS is to keep going, never mind achieve the aspirations set out by the government, warn Jennifer Dixon, chief executive of The Health Foundation and Niall Dickson, chief executive of the NHS Confederation.

Jayne has dementia. Her daughter has taken Jayne into her own home, but neither can cope anymore. The local council has had to close the day centre she used to attend. Exhausted carers, broken social care, neglected and vulnerable patients – it is a shameful story being repeated every day all over the country.

As political minds are distracted by the race to be the next Prime Minister, many may feel the awkward question of NHS funding was settled after the boost announced during the health service’s 70th birthday celebrations last year.

But they would be wrong. Look closely and that announcement was partial, with a promise to deal with the rest in this year’s Spending Review. And the missing elements are critical – there was nothing for disintegrating social care services, nothing for capital spending, nothing for public health, nothing for educating and training staff, and on all of these the health service critically depends.

The latest analysis from The Health Foundation and the NHS Confederation is unequivocal – unless government addresses these areas, the ambitious vision set out in the plan for England will be in jeopardy.

Given the huge extra demands the NHS is facing, politicians need to realise that there’s a big gap between the aspirations they have set out for the health service, and the resources in place to deliver. They will need to be honest about what can and cannot be delivered over the next decade if funding for capital, workforce training, public health and social care continues to be kicked into the long grass. This will need to be near the top of the agenda whoever becomes Prime Minister.

It was exactly a year ago that Theresa May promised profound transformation, better outcomes in cancer care, an empowered workforce and health service leading the world in the use of data and technology. The NHS is coping with year-on-year rises in demand, but as a result, performance against key targets such as waiting times are deteriorating. Despite 100,000 vacancies, staff are giving their all, but need urgent help to reduce avoidable demand and increase productivity using technology.

Demand is growing in part because of cuts to public health and social care funding. The result is that sexually transmitted diseases and other easily preventable public health issues are on the rise again. Emergency admissions are rising for frail older people who could be managed at home if social care were available. Capital investment is too low by international standards – without it, services cannot be leaner, faster and joined up.

The new government will need to accept that while the NHS has had a generous settlement relative to other public services, it has not as yet provided the funding needed to sustain current services in the face of rising demand, let alone deliver improvements and modernisation. Since other public services have been cut to the bone, at some point, we will have to pay more in tax. But it is a choice: higher taxes and a health and social care system that is fit for this and future generations, or taxes at current levels and poorer services.

Niall Dickson is chief executive of the NHS Confederation and Jennifer Dixon is chief executive of The Health Foundation and Follow them on Twitter @NHSC_Niall and @JenniferTHF

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