CSR – part one on health…

Our thoughts so far on what the #SR15 says on health and social care

A sustainable health and social care system

1.96 A fully funded NHS is only possible with a strong economy and strong public finances. The Spending Review announces the biggest ever investment in the healthcare system to ensure high quality and sustainable care for families across the country 7 days a week.

Of course it depends how you look at this – year on year 7.4% increases from 2002 to 2007 were larger proportionally. We concede if you add up the NHS budget from 2016 to 2021, that comes to the biggest ever spend on healthcare….

And in terms of “ensuring” care 7 days a week, well once we’ve paid off the £2.2bn debt and spent £0.6bn on mental health (1.99 below) that leaves £1bn in 2016/17 to fund rising demand, increased weekend working (government still wanting 7/7 increase in hospitals and primary care) and maybe some of the other targeted promises too, e.g. technology? This is a stop-gap. It does not address longer term funding questions – and we are now more than 2% behind GDP spending compared with the European average.

The Spending Review also puts more investment into social care and devolves greater power to local areas to make decisions about their health and social care services to drive forward an ambitious plan to integrate health and social care by 2020.

Read ‘make local decisions’ as ‘raise council taxes’… this is of real concern as the burden will fall on people on low incomes, living in poorer areas with a greater level of need. And PLEASE – we talk about integration until the cows come home but whilst social care remains means tested, we cannot achieve true integration.

A sustainable NHS ready for the future

1.97 The Spending Review confirms that the NHS will receive £10 billion more in real terms by 2020-21 than in 2014-15, with £6 billion available by the first year of the Spending Review (£2bn had previously been announced and given to NHS england and devolved administrations) so that the government fully funds the NHS’s own Five Year Forward View. By taking the difficult decisions required elsewhere, the government is able to increase NHS spending in England from £101 billion in 2015-16 (the front-line budget – not the total healthcare spend) to £120 billion by 2020.

This is £2 billion more than the NHS asked for in its Five Year Forward View. Alongside this, the government expects the NHS to deliver £22 billion of the efficiency savings it said it can find (it said it needed to find, as long as several big “IF”s could be met) in the Five Year Forward View, to deliver the best value from NHS resources.

1.98 The government’s investment will ensure that everyone will be able to access services in hospitals 7 days a week and GP services in the evenings and at the weekend (Sounds like flexibility has been conceded for primary care – most GPs already offer some evening and Saturday morning opening). By 2020-21 the NHS will be funded to provide:

  • 800,000 more elective admissions to hospital for procedures such as operations
  • 5.5 million more outpatient appointments
  • 2 million more diagnostic tests
  • over 100 million more free prescriptions every year

I’m surprised they have listed the items above – it’s what journalists usually do when trying to convey what a certain amount of money would buy – so is this a pledge, what will be in the mandate, or a public-friendly menu of what the money could buy?

  • new hospitals in Brighton, West Birmingham and Cambridge (another one? They’ve just got a new Papworth!! And what about the Peterborough  PFI millstone next door?) over the next 5 years

1.99 This investment will result in faster diagnosis, more effective treatment and greater choice of services, and provide greater funding for new clinical strategies such as cancer and mental health, including:

  • • implementing the recommendations of the Independent Cancer Taskforce so that by 2020 patients referred for testing by a GP should be diagnosed for cancer, or given the all clear, within 4 weeks. This will be delivered by investing up to £300 million a year by 2020 to fund new diagnostic equipment and additional staff capacity, including 200 additional staff trained to perform endoscopies by 2018. More endoscopies has been called for by many, including John Barron MP, Chair of the APPG on Cancer, at 2020health’s 2011 discussion event.  
  • investing an additional £600 million in mental health services. Additional investment will mean that significantly more people will have access to talking therapies every year by 2020. NHS England’s Mental Health Taskforce will report in early 2016 and the government will work with them to set out transformative plans, including for perinatal mental health and coverage of crisis care.

Sounds good – and is welcome – but the reality is that following disinvestment, this just returns funding to previous levels and mental illness prevention and early intervention, IAPT and services for acute mental illness require significantly greater funding. We highlighted some of these inequalities in our report on depression

1.100 The Spending Review reforms the funding system for health students by replacing grants with student loans and abolishing the cap on the number of student places for nursing, midwifery and allied health subjects. The current grant system means that there is a cap on student nurses and over half of all applicants to nursing courses are turned away. This reform will enable universities to provide up to 10,000 additional nursing and other health professional training places this Parliament. This will ensure that there are enough nurses for the NHS while cutting the current reliance on expensive agency staff. The move to loans will also mean access to 25% more financial support for health students during their studies. The government will work with key stakeholders to implement the reforms.

Sounds sensible to us when everyone else in health and life sciences has had to pay their way since grants and were abolished and fees introduced.

1.101 The government will invest £1 billion in new technology over the next 5 years to deliver better connected services for patients and ensure that doctors and nurses have the information they need at their fingertips. By September 2018, 80% of clinicians in primary, urgent and emergency care will have digital access to key patient information. By 2020 integrated care records will give every health and care professional concerned with an individual’s care the information they need to provide safe and prompt care.

We wish the wording was better here – it has been in the past – the records are about us, they should belong to us and be shared by us. Shared care, self-care, information, understanding and confidence will only happen when we have healthcare records with which we can read and write.

The government will invest £10 million in expanding the Healthcare Innovation Test Bed programme. This is fine, but it’s adoption and spread that are the issues – another one for the Mandate?!

This facilitates partnerships between industry and the NHS to make healthcare more effective and efficient by testing combinations of new digital technologies and innovations in NHS services. The Test Bed programme will fund a testing site in every region. YES – the potential is there, but our list of innovation that has been transformational in some areas, in the devolved nations, in other EU countries yet is NOT commissioned or copied here is getting ever longer. Incentives, regulation, funding flows HAVE to change if we are going to reap the rewards of innovation.


About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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