NHS resource pressures - has a tipping point been reached?

RCP president Professor Jane Dacre blogs about the 2017 budget and its implications for the NHS. 

The run up to this year’s budget was unlike any that I have seen. Despite uncertainty looming around the final Brexit deal and concerns about the generational divide, it was the health sector and NHS which took centre stage.

The entire healthcare community was united in its message to the Treasury. The NHS will not be able to deliver the services that we expect of it within its current funding settlement. Both the NHS England CEO Simon Stevens and secretary of state for health Jeremy Hunt told the recent NHS Providers conference that the NHS desperately requires more investment. The Royal College of Physicians (RCP) Council has written to the chancellor outlining our concerns. However, it had less impact than we had hoped, and the NHS was given less than sector experts think it needs.

In the budget the chancellor announced ‘outside the spending review process, [the government is] making an additional commitment of resource funding of £2.8 billion to the NHS in England’. The £2.8 billion will be allocated to the NHS between 2017 and 2020, with £350 million available ‘immediately’ to prepare for winter pressures. This money will also be made to the NHS in addition to the £10 billion extra funding which was promised to the NHS throughout the life of this parliament.  

While it is welcome that the chancellor has recognised the significant funding constraints on the NHS, the announcement has been received with widespread apprehension by the health community, including the RCP. This budget felt like we had been given short-term sticking plasters, rather than the long-term sustainable plan our patients need. The new money falls far short of the additional £4 billion that the Nuffield Trust, Kings Fund and Health Foundation have said that the NHS needs to close the funding gap. Social care funding was not mentioned throughout the chancellor’s entire speech and we all know that many pressures facing the NHS particularly in the acute hospital are the result of restraints on local authority and social care budgets.

But the most concerning news emerging from the budget was the statement made by NHS England’s senior leaders. NHS England's national medical director tweeted that the budget ‘will force a debate about what the public can and can’t expect from the NHS. Worrying that longer waits seem likely/unavoidable.’ And NHS England chair Professor Sir Malcolm Grant stated we can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available. The NHS England board will need to lead this discussion.’

The detail is currently unclear about what will be discussed at the NHS board, however this statement fuels anxiety about the future delivery of care and the availability of services. In our letter to the chancellor we stated that ‘clinicians are increasingly caught between the conflicting pressures of delivering high-quality care that they are trained to provide, and the reality of an overstretched financial settlement available for health services’. At our Council meeting this week, colleagues expressed their frustration at the situation they find themselves in regarding staff shortages and increasing demand. As we said last year, the NHS is underfunded, underdoctored and overstretched. The situation has not improved, and the additional funding announced in the budget is unlikely to be enough to reverse this.

It has been widely accepted that the NHS is one of the most efficient health economies in the world. There are many projects such as the Getting it Right First Time initiative working to further increase the productivity of the NHS. However, only so much can be achieved through greater efficiency and productivity, and only through significant investment in health and social care will we be able to meet the increasing needs of patients in the NHS. There will come a point when the drive for efficiency leads to inefficiency due to lack of resources. Several RCP fellows and members think that point has been reached. 

Professor Jane Dacre, RCP president