How Simon Stevens reset negotiations between the NHS and government

Given his age and political leaning, Mr Stevens is unlikely to be a big fan of Margaret Thatcher. But his message to the service in the wake of the government’s decision to add £2bn to the NHS baseline would certainly have echoes of the former PM’s Falklands exhortation to “rejoice”.

The sum roughly matches the money pledged by Labour at its party conference in September. At the time, HSJ said the cash injection – though welcome – was unlikely to soften the brutality of the efficiency challenge ahead. There is nothing to suggest Mr Osborne’s promise will do more – as HSJ’s exclusive on the details of how the funding will be distributed shows.

However, Mr Stevens would no doubt say this misses the point about what has happened since the publication of the NHS Five Year Forward View.

Not a ‘one off’

He would argue the vision from the combined NHS leadership has made it easier for all politicians to argue for enhanced NHS funding – a point also made by Jeremy Hunt in his interview with HSJ last week and supported by Chancellor George Osborne’s name checking of the forward view in his Sunday media walkabout.

The hope must be that this is not a “one off”, that political behaviour towards the NHS will now be governed by a reasoned response to well thought through and widely supported plans put forward by the service. In this context, the £2bn should be viewed as the opening of new negotiations between government and the NHS over funding which could see further cash upgrades in coming years.

‘The early steer the money did not come with new targets was undermined by the health secretary’

So, as Mr Osborne said, the NHS should consider the £2bn as a down payment on realising the future set out in the forward view and (as he did not say, but undoubtedly requires) focus on demonstrating it can make best use of extra funding.

An early welcome steer was that the money did not come with a raft of new targets or requirements – a very rare thing indeed. This message was somewhat undermined, however, when the health secretary claimed it would only be given to trusts which could provide “assured plans” detailing how they would become more efficient and accelerate their adoption of new technology.  

Mixed feelings

Not everyone in the NHS will be feeling the same levels of positivity in the wake of the announcement. GPs have clearly scored a “big win”. Those who lobbied just as fiercely for extra ring-fenced mental health funding will welcome the £150m for eating disorders, while wondering if such a focus will draw attention away from the need to address the sector’s across-the-board funding cuts.

Chief executives of trusts will be feeling pretty grumpy the 3.8 per cent efficiency target, which history shows is fiercely ambitious, has not been reduced following the cash injection. Meanwhile the NHS and local government staff putting so much energy into the better care fund, may also look askance at the creation of a new ‘out of hospital care’ budget and wonder – with some reason – if central support for the better care fund is turning distinctly lukewarm.

‘Only a relatively small proportion of the funding is aimed at transforming services as envisioned in the forward view’

There has been much uproar over the fact a third of the funding was already in the Department of Health’s budget. The counter is that these resources are now available to NHS commissioners and providers.

The bigger concern is the relatively small proportion funding aimed at transforming services as envisioned within the forward view – as opposed to that devoted to day-to-day fire fighting. Future injections – freed from the context of an impending general election – should have a different emphasis.

Mr Stevens is to be congratulated for securing this win for the service, but he knows better than anyone the work to secure sustainable funding for the NHS has only just begun.