- The government has announced a 3.4% real terms funding rise for the NHS over five years. This is a welcome investment, but there are many demands on this funding. It must pay for recovering current performance and financial gaps, pay rises for staff, keeping up with NHS cost and demand growth, and any early steps to either transform the service or enhance performance in areas like cancer and mental health. It is important not to lose this opportunity to reform NHS services and look to invest in the right services for patients.
- In order to recover gaps in performance, we need to increase capacity in the acute, mental health, community and ambulance sectors, address the costs associated with closing gaps in capital and revenue funding, restore other budgets such as those for staff development; and meet the cost of increasing doctors’ pay.
- To assist the debate on the NHS ten year plan, in which frontline NHS trust leaders must have a key voice, there are a number of areas which need to be addressed if we are to recover NHS performance to a sustainable position (table 14).
- If the NHS is to recover performance against the 18-week referral to treatment standard, that is likely to cost £950m a year for three years. We calculate that the NHS was short of around 7,825 acute inpatients to be able to hit the four hour accident and emergency standard. A conservative estimate would be that it would cost £894m to provide these extra beds.
- Pressures on mental health, community and ambulance services are just as great as those in the acute hospital sector. We have therefore calculated the cost of recovering performance as bringing the reduced mental health and community workforces back up to 2010 levels at an estimated annual cost of £346m. Given the pressures on these services, recovering performance – through the increasing the workforce – is only the initial element of what is required to ensure these services better meet patient need and demand. Further expansion of these services will be required.
- The cost of eliminating the current trust sector deficit is between £645m and £960m a year. Trusts are also currently excessively reliant on non-recurrent savings, such as land sales. We estimate that a sustainable level of savings would require £500m a year of extra provider funding.
- Tackling high and significant estates risks and preventing any new backlog from arising will cost at least £1.2bn a year for three years.
- We need to recognise how dependent the NHS is on wider public services, in particular public health and social care. Ensuring that these services are sustainably funded is crucial to the success of the health and care system over the next ten years.
- Our view is that recovering lost ground would take up much if not most of the additional NHS spending, restricting the options for other key priorities. The cost of recovering the financial and operational gaps shows that difficult the choices in the new NHS ten-year plan will be required.