NHS in crisis: next year's money looks a bit better, but is it really?

Written by Tony Millett on .

Today (February 8) was not the best day for NHS England to have their board meeting:  figures were announced showing that January was one of the most difficult months on record for the NHS. 


Despite moves to ease pressures on hospitals - including the mass cancellation of routine operations - record numbers of seriously-ill patients faced delays waiting for a bed with 1,000 waiting over 12 hours.

GWH's emergency department missed the 95 per cent target for patients to be treated or admitted within four hours.  GWH hit 84.8 per cent against the average for England of 85.3 per cent - putting them at fifty-sixth place out of the 133 hospitals.


January 2018 A&E figures - GWH's position in red (BBC News graphic){Click to enlarge) January 2018 A&E figures - GWH's position in red (BBC News graphic){Click to enlarge)

But GWH did meet the target for cancer patients to begin treatment within 62 days of an urgent referral by their GP.


At their board meeting NHS England confirmed government funding for the NHS in England for the next financial year - 2018/19.  The budget will grow by £2.14billion.

This is made up of the extra £1.6billion announced in the Chancellor's Autumn Budget plus a further £540million that the Department of Health and Social Care has 'made available'. 

NHS England has outlined how it will allocate this money.  An extra £400million will go to Clinical Commissioning Groups (CCGs) - on the understanding that they will balance their books by the end of the financial year.

And there is a £2.45billion 'sustainability fund' which hospitals will earn a share of when they 'constrain non-elective activity growth levels at or below locally agreed plans' - or, in plain English, meet the four hour target for their A&E departments.

We will undoubtedly be told by government MPs that this settlement is a wonderful increase in funding of '2.4 per cent in real terms'.  However, look a little further and "Factoring in England's growing and ageing population, age-weighted revenue growth per person becomes 1.4 per cent in 2018/19."  Or less than half the rate of inflation.

Under current government plans for NHS funding, the real terms growth for the following year (2019/20) will be 0.2 per cent and the age-weighted growth per head goes into the red at minus 0.8 per cent. 

Among the headline plans for next year are expansions in the primary care workforce "including 600 international GP recruits, another 500 clinical pharmacists, and 1500 mental health therapists working in primary care."  Let's hope NHS England have told the Home Office about these plans and the international doctors' pay will be above the salary threshold needed to qualify for a visa to work in England.

Those funding figures for 2018/18 cover running costs for the NHS in England.  Capital costs are another matter entirely - as people in Devizes are finding out.  The new Devizes Urgent Care Centre was supposed to open in 2017.  As yet not a brick has been laid.

The site is now owned by NHS Property Services - the organisation set-up under the 2012 Health and Social Care Act (part of the Lansley reorganisation of the NHS).  All Wiltshire's community hospitals and buildings will eventually be handed over to NHS Property Services.

The site for this centre was transferred to their ownership free of charge and they will - eventually - charge Wiltshire CCG rent for the new building.  But NHS Property Services are not funding the construction and fit-out.

In 2016, when the plans for the new centre went on public view, it was said that "Capital funds will be raised through the sale of the Devizes hospital site and some surplus land currently owned by NHS Property Services on Green Lane in Devizes." Have the proceeds of the sale of NHS land simply been transferred to the Treasury?

The primary care element of the new centre will be funded through NHS England's Estates and Technology Transformation Fund.  Funding for other parts of this development will need to be agreed 'via other routes'.

One route could be Project Phoenix.  This is a long-planned public private partnership or PPP.  But after years on the drawing board, Project Phoenix is currently going through 'a national validation process'.

A PPP looks pretty close to the much-reviled PFI funding schemes.  It will be interesting to see how PPP protects the tax-payer against extreme profits made by lenders.

Also key to any PPP deal for the Devizes Urgent Care centre will be whether the funding includes maintenance.  It is often overlooked that many PFI deals guarantee maintenance and in some cases equipment upgrades as well - by including those costs in the annual PFI repayment fee.

With a negative funding settlement for 2019/20, it is hardly likely that hard-pressed hospitals and other providers struggling to provide safe and sufficient front-line services, will find 'spare' money for maintenance - unless they are forced to by their PPP deal.