Speculative Diversion: Rumours of Financial Meltdown in the NHS? Collective Delusion or a True Concern?

Summary

There are mounting tales of financial distress from different quarters, seemingly pervading the NHS root and branch. Independent observers might begin to wonder whether these reports do indeed reflect a factual underlying trend, or merely express a collusional myth propagated on the part of: (i) a political opposition, parts of which at least are covertly determined to “weaponise the NHS”, (ii) NHS managers seeking justifications for ever more Government bailouts (the “rewards for failure” entitlement mindset), (iii) the press / political commentariat with an insatiable appetite for headline grabbing “news”, (iv)sock puppet” charitable campaigning organisations and / or (v) other parties as yet unidentified (for example sectional interest groups, whether inside or outside of the NHS). The only sensible approach is to monitor the latest reports, with a due sense of skepticism and informed disbelief (more usually known as critical reflection).

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Reference

Triggle, N. (2015). NHS trusts’ overspend hits £1.6bn. London: BBC Health News, November 20th 2015.

Counter-Balancing Evidence

Without falling into an “either / or” false dichotomy, contrary evidence is available for readers with the will to absorb it:

Fact

Front-line NHS services in England have received an above-inflation £3.8 billion cash injection; representing an increase of nearly 4% on NHS England’s previous £101 billion front-line budget.

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Reference

Triggle, N. (2015). NHS to get above-inflation £3.8bn cash boost next year. London: BBC Health News, November 24th 2015.

On the other hand, there are mounting hospital deficits and higher pension costs:

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Reference

Pym, H. (2015). Osborne’s NHS cash pledge ‘has unravelled’, says Labour. London: BBC Health News, December 23rd 2015.

Suggestions have since emerged that the basic FYFV financial projections may have been amended early on by interventions by Downing Street:

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Pym, H. (2016). The curious tale of £22bn NHS efficiency savings. London: BBC Health News, March 20th 2016.

On balance, the Nuffield Trust points to concerns about cuts to Department of Health budgets and reductions of £600 million for local authority public health grants:

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Reference

Spending Review 2015: what it means for health and social care. Nuffield Trust Parliamentary Briefing. London: Nuffield Trust, December 3rd 2015.

Note: Furthermore, when an irreproachably bias-free organisation such as the National Audit Office (NAO) comments on widespread deficits in the NHS having become endemic and a matter of concern, then it perhaps becomes time to acknowledge that financial problems are not merely being “talked-up” needlessly. A total deficit of over £2 billion is forecast by NHS trusts this year; following on from an overspend of over £840 million last year.

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Triggle, N. (2015). Financial problems ‘endemic’ in NHS. London: BBC Health News, December 16th 2015.

This relates to:

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The Comptroller and Auditor General of the National Audit Office: Morse, A. (2015). Sustainability and financial performance of acute hospital trusts. National Audit Office Report (HC 611). Session 2015-16. London: The Stationery Office [Department of Health / National Audit Office (NAO)], December 16th 2015.

There is also an Executive Summary.

By February 2016, estimates by the King’s Fund were worse:

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Reference

Brimelow, A. (2016). NHS trusts may hit £2.3bn deficit, report warns. London: BBC Health News, February 18th 2016.

Further analysis:

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Triggle, N. (2016). Virtually all hospitals now in deficit. London: BBC Health News, February 19th 2016.

NHS England Service Improvements: Investment of Additional Funding

NHS England has released an account of how the NHS budget for the next five years is to be allocated, including the additional £8.4 billion real terms NHS funding growth agreed by the Government. This is supposed to be where the “rubber hits the road” on advancing the financial sustainability of NHS services.

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NHS England allocates £560 billion of NHS funding to deliver NHS Five Year Forward View. [Online]: NHS England, December 17th 2015.

This relates to:

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Baumann, P. (2015). Allocation of resources to NHS England and the commissioning sector for 2016/17 to 2020/21. London: NHS England, December 17th 2015.

“Annual funding will rise in real terms by £3.8 billion in 16/17 and £8.4 billion by 2020/21”.

Further details and explanation:

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NHS leaders set out new long-term approach for sustainability and transformation. [Online]: NHS England, December 22nd 2015.

This relates to:

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Delivering the Forward View: NHS shared planning guidance for 2016/17 to 2020/21. London: Monitor; NHS England; NHS Trust Development Authority; Care Quality Commission; Health Education England; National Institute for Health and Care Excellence and Public Health England, December 22nd 2015.

The main document is shown below:

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Reference

Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21. London: NHS England; NHS Improvement (Monitor and the NHS Trust Development Authority); Care Quality Commission (CQC); Health Education England (HEE); National Institute of Health and Care Excellence (NICE) and Public Health England (PHE), December 22nd 2015.

Could a Cross-Party Commission Provide the Solution?

Former health secretaries / ministers Stephen Dorrell, Alan Milburn and Norman Lamb have recommended the creation of a cross-party commission to review the future of the NHS and social care in England. Both systems are rumoured to face an “existential crisis” due to rising demand relative to funding and capacity.

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Cross-party review ‘needed for health and care’. London: BBC Health News, January 6th 2016.

See also:

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Charities urge Cameron to boost NHS and social care. London: BBC Health News, January 9th 2016.

Related:

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Reference

Humphries, R. Thorlby, R. [and] Holder, H. [et al] (2016). Social care for older people: home truths. London: King’s Fund [and] Nuffield Trust, September 2016.

Almost £1 Billion Funding for Mental Health Treatments

David Cameron recently announced an “assault on poverty”, which will include various reforms including improvements to mental health services, with increases in funding for specialist pre- and post-natal care for mothers, mental health services in hospital emergency departments and community-based treatments.

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David Cameron pledges ‘assault on poverty’ with social reforms. London: BBC Health News, January 11th 2016.

This relates to:

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Prime Minister pledges a revolution in mental health treatment. London: Prime Minister’s Office, Rt Hon David Cameron MP, Rt Hon Jeremy Hunt MP, Department of Health and NHS England, January 11th 2016.

Further Updates

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Reference

Pym, H. (2016). NHS finances – the short, the medium and the long term. London: BBC Health News, February 5th 2016.

Public Dissatisfaction With the NHS?

Historically the largest rise in public dissatisfaction with the NHS has been recorded by the British Social Attitudes Survey. Overall, levels of satisfaction are still high by historical standards however.

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Reference

Triggle, N. (2016). Record rise in NHS dissatisfaction levels – survey says. London: BBC Health News, February 9th 2016.

International Comparisons and Health Spending Expressed as a Proportion of GDP

Questions of political will… Equally, questions of affordability and sustainability in an uncertain economic context…

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Reference

Triggle, N. (2016). Is enough being spent on the NHS? London: BBC Health News, February 25th 2016.

Talk of Perfect Storms

The following Health Foundation report examines the financial performance of NHS providers and the commissioners of care (NHS England and the Clinical Commissioning Groups).

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Reference

Lafond, S. Charlesworth, A. [and] Roberts, A. (2016). A perfect storm: an impossible climate for NHS providers’ finances? An analysis of NHS finances and factors associated with financial performance. London: Health Foundation, February 29th 2016.

NHS failures and endless “Winter pressures” are alleged to have become the new norm:

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Reference

Triggle, N. [and] and Dreaper, J. (2016). Endless winter in NHS ‘puts patients at risk’. London: BBC Health News, June 21st 2016.

Hints widespread staff defeatism and demoralisation?:

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Reference

Triggle, N. (2016). Has NHS failure become the new norm? London: BBC Health News, June 21st 2016.

Contrast this with the official view (contemporary):

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Reference

Simon Stevens speech to NHS Confederation Conference 2016. [Online]: NHS England, June 20th 2016.

Growing Crisis in the NHS?

A King’s Fund briefing identifies three challenges for the NHS in England:

  1. Sustaining existing services and standards of care.
  2. Developing new and better models of care.
  3. Tackling challenges by reforming the NHS from within.

“The impact of the Spending Review on social care is uncertain, but overall will not be enough to close the funding gap, which we estimate will be between £2.8 and £3.5 billion by the end of the parliament”.

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Reference

Ham, C. McKenna, H. [and] Dunn, P. (2016). Tackling the growing crisis in the NHS: an agenda for action. London: King’s Fund, April 7th 2016.

The May 2016 issue of the King’s Fund Quarterly Monitoring Report is quite negative about the outlook.

Fact: NHS England’s Five Year GP Strategy

The five-year plan to help GP surgeries involves an additional £2.4 billion per year being invested into GP services by 2020; this is an increase of 14% in real terms.

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Reference

Triggle, N. (2016). NHS in £2.4bn funding boost for GP services in England. London: BBC Health News, April 21st 2016.

This relates to:

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Reference

General Practice Forward View [April 2016]. London: NHS England, April 20th 2016. Gateway Publication Reference No. 05116.

Staff Morale?

Some allege that a corrosive decline in workforce morale could present a greater risk to the NHS than financial problems per se.

Investment in Training Doctors

The number of medical school places is to increase by 25% from 2018; with a rise in doctors’ training places costing £100 million from 2018 to 2020. Medical students will be required to work for the NHS for a minimum of four years, as the cost to the taxpayer over the five-year degree is approximately £220,000.

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Student doctor numbers to rise by 25%. London: BBC Health News, October 4th 2016.

NHS Finances Outside the EU (Health Foundation)

The following Health Foundation briefing discusses the impact of the UK leaving the European Union on NHS finances. Based on earlier analysis from the National Institute of Economic and Social Research (NIESR) and the Institute for Fiscal Studies (IFS), this briefing projects an NHS funding shortfall of over £16 billion by 2030/31 before considering the impact of leaving the EU.

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Reference

Briefing: NHS finances outside the EU: Health Foundation analysis of the impact on NHS finances of the UK leaving the European Union. London: Health Foundation, July 4th 2016.

See also:

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Reference

Pym, H. (2016). NHS finances – back under intense scrutiny. London: BBC Health News, July 8th 2016.

Where to Now For The Optimism Bias?

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Pym, H. (2016). Pressure intensifies on squeezed NHS. London: BBC Health News, August 5th 2016.

This relates to:

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Gainsbury, S. (2016). Feeling the crunch: NHS finances to 2020. London: Nuffield Trust, August 5th 2016.

There is also an Executive Summary.

An earlier King’s Fund report:

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Reference

Dunn, P. McKenna, H. [and] Murray, R. (2016). Deficits in the NHS 2016. London: King’s Fund, July 2016.

More BBC comment / analysis:

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Reference

Triggle, N. (2016). NHS funding: Is £10bn rise really a cut? London: BBC Health News, October 20th 2016.

The Health Select Committee, chaired by Dr Sarah Wollaston, chime in with an open letter, with the focus of concern being cuts to local authority budgets for social care, health education and public health:

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Reference

NHS funds need urgent boost, say MPs. London: BBC Health News, October 31st 2016.

See further:

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Pym, H. (2016). NHS funding and rationing: the debate intensifies. London: BBC Health News, October 31st 2016.

Government Response on the 2016 Spending Review

The Government’s response to the House of Commons Health Select Committee report on the relevance of the spending review for health and social care:

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Reference

Government Response to the House of Commons Health Select Committee Report into the Impact of the Spending Review on Health and Social Care (First Report of Session 2016–17). London: Department of Health, December 16th 2016. Cm 9385.

BMJ Series on the NHS in 2017

A BMJ series of articles on the challenges facing the NHS:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Iacobucci, G. (2017). NHS in 2017: A service under pressure. British Medical Journal (BMJ). January 3rd 2017; 356: i6691.

A BBC News perspective on the year ahead:

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Reference

Triggle, N. (2016). Is the NHS going to break in 2017?. London: BBC Health News, December 29th 2016.

The Sick Man of Europe (Redefined)?

There was an unprecedented media / political frenzy about the dire state of NHS performance in the early weeks of 2017. Strangely, other Europe nations suffered much harsher winter conditions, yet (apparently) experienced little in the way of health crises or widespread moral panic.

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