Revealed: The reality behind the 2019–24 NHS funding settlement

Five pound note

A new infographic has shown the reality of the NHS' five-year funding settlement, what it will mean in practice and what is needed to deliver it.

The reality behind the 2019–24 NHS funding settlement outlines the financial challenge facing the NHS over the next five years. It warns that commissioners and providers will need to continue to make considerable efficiency savings to remain in balance.

Pressures such as stabilising waiting times, increasing staff pay and addressing population growth, ageing and chronic conditions are expected to reach as much as £31bn by 2024, far exceeding the £20.5bn pledged by the Prime Minister in June 2018.

The document also looks at why the NHS deficit has developed, despite considerable efficiency savings delivered by both providers and commissioners.

System-wide challenges

This is the first time that the NHS Confederation, NHS Clinical Commissioners (NHSCC) and NHS Providers have come together to highlight the financial challenges faced by the system. They call for a realistic NHS plan, coupled with a funding plan for social care, that:

  • prioritises what the NHS can achieve within the funding available,
  • identifies what we could stop doing to remain sustainable in the future and focus on funding what works for patients,
  • sets realistic levels of efficiency savings,
  • supports collaboration by removing financial and regulatory barriers to local integration,
  • outlines support for the current and future workforce, and
  • focuses on prevention and reducing health inequalities.

James Rimmer, co-chair of NHSCC’s Finance Forum and chief financial officer of Southampton City CCG, commented: “The funding settlement announced earlier this year, whilst better than many other government departments’ settlements, it is still generally thought to fall short of everything needed to modernise and transform the health service.

On a daily basis, clinical commissioners are forced to make difficult decisions that balance the needs of the individual against those of their entire local population and this will clearly continue to be important over the next five years.

“At NHSCC, we have long been calling for an honest conversation with the public, patients and clinicians about what the NHS should and can provide, and that conversation has now become even more critical to ensure we get best the value from the limited NHS pound and only spend it on what we know works best for patients.

"We hope this infographic, which draws on the experience of clinical commissioners, providers and health system leaders, will provide focus for the development of the NHS long-term plan.”

Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:

“One of the biggest dangers in the forthcoming plan is that we over promise and under deliver. We have done better than other parts of the public service but the road ahead is still strewn with tough choices.

“The government and indeed the public will want to see results from additional investment but we must be realistic about what can be achieved from a system that is already under such intense pressure.”

Amber Jabbal, head of policy at NHS Providers, said: “The ten-year plan represents the best opportunity to put the NHS on a foundation which ensures it meets the needs of the future. “The plan must be ambitious. But it must be built upon realistic assumptions about what can be delivered with the funding increase announced. Our report on efficiency in the NHS published this week explored this in more detail.

“The funding settlement must help the health service recover performance, improve outcomes in areas such as cancer and mental health and continue to bring health and care services together in a more joined up way. There will be tough choices ahead.

“It must also confront the realities of a growing and ageing population which is living longer, but with an increasing number of long-term conditions and complex care needs. This is why the question of how we fund social care is equally as important. Without investing adequately in our social care system we risk diluting every pound invested into the NHS.”

Find out more

Download the infographic and list of sources.

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