In pointed remarks made on Friday and aimed at the health secretary, Simon Stevens said people should not “rewrite history” on the exact sums the NHS in England will need by 2020. Hunt has repeatedly stressed that the government has pledged to boost the NHS budget by £8bn over that period because that is the amount set out in a blueprint unveiled in 2014 called the NHS Five Year Forward View, which Hunt, David Cameron and George Osborne now call “the Stevens plan”.
In a major speech on Friday to NHS leaders, Stevens reminded Hunt that the document said the health service would need £8bn-£21bn by 2020, and would only cope with the smaller amount if major progress was made on improving social care, public health and how NHS care was delivered.
Social care has deteriorated since the blueprint was published and will continue to do so for the next three years, he said. Organisations such as the Local Government Association, Age UK and the NHS Confederation – whose annual conference Stevens was addressing – have all said that the unmet need for social care, caused by Whitehall cuts to local council budgets, will continue to increase already heavy demand for NHS services, particularly A&E care and GP appointments. Patients are also having to stay longer in hospital than they should, despite being medically fit to leave.
Stevens, the chief executive of NHS England, laid out what he called “a few home truths” about health service funding to an audience of 1,000 NHS senior managers. “Let’s not rewrite history. In the Forward View we actually said that the NHS would need between £8bn and £21bn by 2020 in order to sustain and improve,” he said.
“And to be at the lower end of that range, we would need to see continuing access to social care, relative to need, we would need to see enhanced effort on prevention and public health, and we would need to see transformation [of how NHS services are organised].”
NHS England was pressing ahead with the latter point through 44 regional “sustainability and transformation plans” and giving every hospital trust a “control total” – the exact amount of money it must save in 2016-17 – to help the tackle the £2.8bn deficit the trusts ran up last year, Stevens said. But the outlook for social care was bleak, he said, adding that he was sympathetic to a delegate from West Berkshire who said that social care funding in her area had been cut. One of the three local councils nearby had reduced it by 40%, she said.
In reply, Stevens said: “The social care funding thesis is unfinished business. It is obvious that there is going to be a widening gap between need and funding over the course of the next three years.” Awareness of the damage caused by poorly-funded social care services had grown recently, but ministers needed to “move from acknowledgement to solution”, he said.
Despite ever-increasing demand for NHS care, the service was unlikely to get any more than the extra £8bn the government has pledged, he told delegates. “Times are clearly tight and tough. I do not believe that it would be prudent for us to assume any additional NHS funding over the next several years, not least because I think there is a strong argument that were extra funding to be available, frankly we should be arguing that it should be going to social care. I think social care has a very strong case for that”, Stevens said.
Stephen Dalton, the NHS Confederation’s interim chief executive, said: “Simon Stevens is right to say that social care funding is unfinished business. Future extra investment needs to go towards a sustainable, well-funded social care system. The NHS recognises that without social care funding both the NHS and wider care sector will suffer.”
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