Does the NHS face another year's misery?

Hugh Pym
Health editor
@BBCHughPymon Twitter


A long-term funding plan, a multi-year settlement and getting away from annual budget top-ups - that was the eye-catching commitment for the NHS in England made by the prime minister.

The ambition is bold, though there is no detail as yet on the likely sums of money involved.

Long-term thinking for the NHS is what most of the key players have been calling for.

But what about the short term, which is what many patients and staff will be interested in?

The answer is that the pressures seen in the system in recent months are likely to continue, with waiting times rising.

The scenes of crowded accident and emergency departments, with trolleys carrying patients jammed together, illustrated vividly by the BBC series Hospital, could well be repeated next winter.

Theresa May's plan will not start to take effect until April 2019. There is a full financial year to get through before then. And there has been no new offer of funding for that.

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NHS Providers, the organisation representing hospitals and other trusts in England, has said things will get worse before they get better.

It has welcomed the announcement of Mrs May's plan but said its main concern is the 2018-19 year that is about to begin.

It warns of growing risks to quality and safety, adding to the burden on the workforce.

The organisation says more than 80% of hospitals believe they cannot stop waiting lists rising for non-urgent operations such as hip and knee replacements and by March next year more than half a million patients in England will be waiting more than 18 weeks.

In A&E, the prediction is that over the year more than 3.6 million patients won't be treated within four hours .

Government narrative

The government will hope they at least have a narrative to handle questions about the state of the NHS in the months ahead.

A commitment to a plan that in the prime minister's words will be "properly resourced" will sound more positive than the defensive tone adopted in recent months.

It is certainly a shift in Mrs May's position. She rebuffed an approach by 90 MPs last autumn calling for a cross-party approach and a long-term plan for the NHS and social care in England.

But a similar letter this month was followed within days with the new funding pledge and an attempt to reach out to parliamentary leaders to work with her, including Sarah Wollaston, who chairs the Health Select Committee, and Norman Lamb, who chairs the Science and Technology Committee.

Her former policy adviser Nick Timothy is understood to have been a go-between, encouraging the prime minister to take a new approach.

The Health and Social Care Secretary Jeremy Hunt has been arguing in cabinet for a new stance. He has advocated a 10-year planning blueprint for NHS resources and workforce.

The timetable for the new plan is not clear. Theresa May has written to the head of NHS England, Simon Stevens, asking him to set out long-term goals and priorities by this summer.

In effect, he is being asked to draw up an outline of a new Five Year Forward View. It seems likely that ministers will want to use this as a staging post in the development of their long-term plan.

The 70th birthday of the NHS in July will offer a convenient opportunity for the government to set out its thinking.

What everyone will want to see is the spending detail and how much money has been allocated to the NHS in England for the next five years and beyond.

Under the traditional formula, Scotland, Wales and Northern Ireland will gain proportionately from any increases in spending announced for England.

Barring a miracle, this will not be ready by the summer. The autumn Budget seems more likely for news of the financial underpinnings of the new plan.

With a new policy paper on social care due in the summer, there will be a busy few months of speeches and announcements.

But what will really matter for the NHS will be the new money and that will not materialise until another winter of pressure has been endured by patients and staff.

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