Report warns NHS has insufficient funding for rapid recovery

The two bodies’ latest performance tracker provides a ‘stocktake’ following the autumn statement, highlighting the impact of strikes on staffing in public services and warning that backlogs won’t improve until the period of industrial unrest is ended. The government had refused to meaningfully discuss pay and introduced a bill to ensure minimum services during strikes, it said: this strategy damages the performance of public services and will in many cases exacerbate the problems driving staffing crises.  

And it is highly critical of the impact of political instability on the NHS, saying: ‘Despite the “twindemic” of flu and Covid hitting hospitals and general practice as predicted, too little was done to prepare, in large part due to the political instability and administrative paralysis caused by the defenestration of two prime ministers over the summer and autumn.

While the NHS did get extra funding to enable it to cope with inflationary pressures and demographic demand in the autumn statement, ‘it does not provide the level of funding required for major improvements to performance’.

The additional funding will not be enough to cover backdated inflation-level wage increases for 2022 and, without more funding, an increased share of budgets will be needed to cover higher pay rises if they are used to bring strikes to an end, it continued.

‘Performance in some services has got substantially worse over the last three years and reversing that will require considerable effort. As such, performance in these services is unlikely to return to pre-pandemic levels before the next election. This means that hospital waiting times and lists will remain above where they were in 2019,’ it concluded.

‘Returning services to pre-pandemic performance levels, never mind those of 2010, is a daunting task. There is precedent for such an improvement, though: New Labour turned around a comparably bad NHS in the 2000s. But this required sustained investment, rather than short-term funding in responses to crises, and a strong focus on reform.’ 

The report said:

• The NHS has become better at ramping up its Covid response, but the pandemic is still having an impact on hospital productivity. However, the current crisis was not inevitable – or solely due to Covid – but was ‘driven by more than a decade of relative underinvestment.’
• Hospitals found some efficiencies during the pandemic through measures such as virtual wards and reducing face-to-face outpatient appointments, including a switch to patient-initiated follow-up in some cases. But there was decline in many areas of hospital activity, which, together with rising costs, mean the NHS is less productive than before.
• Difficulties in discharging patients is contributing to high bed occupancy and capacity issues. While some funding has been released to address this, ‘its short term and haphazard nature makes it very difficult for the service to effectively plan and spend the money’.
• The NHS is undermanaged compared with other health systems. While the numbers in other staff groups have increased dramatically since 2009, the number of managers has not kept pace and declined sharply after the Lansley reforms. Investment in management can improve productivity, but governments have taken a ‘dismissive attitude’ to managers.
• While staff numbers have increased, the rise in staff leaving is having an impact on vacancy rates. Work-life balance is an increasing factor in resignations but uncompetitive pay – worsened by high inflation – is also affecting retention.
• Spending on general practice soared during the pandemic and it is unclear how much of this will need to continue to deal with ongoing Covid pressures.
• Despite difficulties in quantifying demand for general practice, there is evidence of substantial unmet demand and declining public satisfaction with services.