NHS bosses continue battle with the Government - Dods Monitoring

Posted On: 
1st December 2017

NHS England held their regular Board meeting yesterday, but this one was never going to be your standard “apologies for absences” and jugs of warm water affair, says Dods Political Consultant Bruce Reilly.

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It was the first to be held after the Budget last week, where the Chancellor failed to give the NHS the money its Chief Executive, Simon Stevens, had so publicly (and politically) said was needed for demand to be met.

The vocal warnings over the state of the health service continued on Budget day, with the outgoing medical director Sir Bruce Keogh expressing his view that the promised spending levels would "force a debate" about what the public could expect from the NHS. Chairman of NHS England, Sir Malcolm Grant, added that the difficult debate about what was possible for the health service to deliver could no longer be avoided. That's about as catty as it gets in healthcare politics, but these remarks came in the context of missed waiting-time targets and plans to limit the prescription of certain medicines, so it didn't take much to add to the pressures on the Government.

What transpired in Skipton House certainly showed just how much the NHS is going to have to stretch to meet its funding shortfall. Given the revenue confirmed in the budget for this winter, it forecasts that the waiting times enshrined in the NHS constitution would not "in the round" be fully funded or met. The Board also emphasised the need to set "realistic" plans for the growing level of emergency care next year. These are issues that the Health Select Committee has been probing ministers and officials on for some time now, and these remarks will only reignite the issue.

The coalition of health and care charities, National Voices, described the plans to limit the prescription of a number of "low-value treatments" and medicines available over the counter as risking adverse effects on "most vulnerable in our society and those who are ‘just about managing’." They argue that the proposals from the Board would limit access to treatment to people on JSA and ESA. Stevens himself has described the NHS as a solution to another of the PM's personal priorities, the "burning injustices" in society. Whilst the confirmation that mental health and cancer and services would be protected was welcomed, the Government will be squirming at the suggestion that their own political funding choices will deny access to basic treatments for the least well-off.

Of course, these decisions will be subject to a likely difficult period of engagement with the public and patient groups as well as tense discussions between the NHS and DH too. If Hunt is forced to make changes to the NHS constitution in the form of extending waiting times in the lead-up to the NHS' 70th birthday next year, it will be a lightning rod for all those campaigning for patients, carers and staff. If the rumours of a 2019 leadership bid from the health secretary are to be believed, he's going to want to avoid another junior doctors strike-sized pile of bad press.

In the Budget, the Chancellor continued the blame-game by making clear that the money he pledged was enough for Stevens to ensure the NHS improved its targets. Yesterday's decisions were in many ways putting the ball back in the Government's court.

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