Comment / Ker-Plunk!

Until 18 April, most of us would not have imagined a UK general election before 2020, certainly not before the Brexit pathway was clearer. In the near term, this would have meant continuing to plan for macro NHS funding in line with the ‘funding U-bend’ settlement. And it would have meant planning for operational service priorities and access targets clarified by the recent Next steps on the NHS five-year forward view publication.

In that context, the outlook for next three to four years was clear enough, albeit challenging locally to continue to sustain high-quality services alongside transformation programmes at varying degrees of infancy.

The uncertainty we accepted was not knowing what the next Parliamentary term looked like in terms of funding plans and priorities for the medium term beyond 2020. With a general election now on 8 June, that void of uncertainty has narrowed.

Early indications suggest that, putting aside political manifesto commitments expected over the next few weeks, we will probably still have to wait for the longer term direction of health and care to be confirmed.

In any election outcome scenario, it is hard to see how the country could avoid a future choice between increased health and social care funding or changing the services currently delivered free at the point of need for all. Commitment to an early cross-party review of NHS and social care needs would be a good place to start. 

Reaffirmation of the NHS founding principles in the first 392 days of office – and ahead of its 70th anniversary – would be cause for celebration. If this comes with a commitment to move our health spend as a proportion of gross domestic product in line with some of our European neighbours, I’ll bring the cake on 5 July 2018 and you can eat it. And that’s a promise.

But back to the election announcement: where does it leave us? The 2016/17 consolidated financial position will be known soon. Organisational performance has been declared and is now with the individual auditors for verification. 2017/18 is under way and, setting aside the £325m capital distribution for well-developed sustainability and transformation plans, closing out residual financial gaps is at the top of the ‘to-do’ list for most. Managing down system demand to within broadly flat funded activity assumptions isn’t far behind. 

Achieving both these while also reducing A&E waiting times is important not only for patient experience, but also for (STF) cash balance assumptions.

From my vantage point – looking out from a health and care system that is broadly doing what it said it would do across a broad performance scorecard – two things are clear. First, if we are serious about reducing unwarranted variation at scale, we can probably iron out the remaining efficiency wrinkles to sustain services for another year at current levels. Being serious, however, means organising ourselves on an industrial scale to underscore the ‘national’ in NHS. Waiting for this to happen organically may be too late.

So there’s the other thing. Doing the same thing that we have always done in the same way we’ve always done it, and continuing to take out efficiencies of 4% a year, well, that would be like playing Ker-Plunk in the dark and against the clock.

The NHS is worth more than that. Patients, service users, carers and families deserve better. 

Everyone counts. Our job is to keep going. But our responsibility is to be true to the services we support and to demonstrate efficiency beyond public doubt. 

As the UK’s best loved institution, let’s not rest on our laurels. Guardians of the money need to become gladiators of change. 

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