On Tuesday, just two days before parliament starts its recess and less than a week after Theresa May first addressed the commons as Prime Minister, Sir Simon Stevens, CEO of NHS England, wrote about his priorities for the NHS.
For most of us his comments and overall strategy will seem eminently sensible. The question I ask myself is this: Will Theresa May’s government pay lip service to Simon Stevens’ strategy or will they actually commit to the funds and action needed to carry it through?
You might say I am being unduly cynical and that I am not giving this new PM a chance. You may be right, although keeping Mr Hunt as her Secretary of State for Health does not strike me as very smart, given that he is so toxic to the doctors.
Stevens expresses concerns about two policy areas in particular – obesity & mental health, both of which are not getting the focus they deserve.
He points out the vital importance of effective action on obesity. This is not a matter of the nanny state lecturing people on how much they should eat. This is a critical health issue that affects the whole health service, not just in terms of funding but through the need to treat a whole range of different diseases. Financially the cost to the Treasury is now more than the police and fire services combined. One result of the separation of our health care services into NHS, on the one hand, and local authority social care and public health responsibilities on the other, is that it is your under-funded local council’s job to prevent obesity but it is the NHS that has to treat the myriad of diseases that arise from it. However, there are strong rumours that the long-awaited obesity strategy has been weakened because of business lobbying since it was first mooted by the government last year, while the LGA reports that funding cuts are threatening councils’ ability to be effective in this and other areas of public health.
Whatever the rights and wrongs of the Coalition we can all be enormously proud of Norman Lamb’s work on mental health as a minister. He continues to campaign for adequate funding and parity of esteem for mental health services. Simon Stevens writes that his blueprint, about to be published, will radically improve this under resourced area of health care. My problem is that since May 2015 multiple promises on mental health have not been kept. It seems that money earmarked, but not ring-fenced, for CCGs to fund mental health treatments may well not have gone for that purpose but has been used to plug other black holes. As the Select Committee on Health Report (Impact of the Spending Review on Health and Social Care) points out:
The scale of the funding challenge is colossal, especially given the timescale for achieving it.” Saffron Corderey of NHS Providers writes: “We support the strong message throughout (the Five Year Forward View) that the funding arrangements will only work if the full amount is passed on to providers.
I am also very concerned about the following statement from Simon Stevens’ article:
…to help balance the books, the NHS is currently switching billions of pounds of capital investment into day-to-day running costs.
This is outrageous at a time when interest rates are at an all-time low. No more expensive PFI schemes please. I do agree with him that Government should allow the NHS to borrow the money for replacing clapped out facilities BUT they should be designed to house modern integrated services, not just copying what went before with shiny new ‘more of the same’.
I could write far more, for instance about his statement that for years hospitals’ share of funding has grown rapidly at the expense of primary care. What we really need to do is to replace crude activity targets with whole community Accountable Care outcomes, but that is for another article.
* Joan Walmsley is a Liberal Democrat member of the House of Lords