NHS Chief gears up for Budget day battle
With Budget Day fast approaching, Simon Stevens, the Chief Executive of the NHS, set out his stall with one of his most political speeches yet, which is saying something for a public servant with a history of openly contradicting the Government. But what do his remarks say about the state of the NHS and how this will impact the politics surrounding the health service? Stevens certainly knows how to target the Government’s weaknesses, focussing on Brexit, public sector pay and NHS funding. It was also one of his most ominous, describing the current funding settlement as falling well short of what was needed and claiming that 2018 would be one of the toughest years yet. He compared the Government’s spending plans with France and Germany, calling for an additional £20-30bn a year if we wanted our healthcare system to look and feel the same. With less than two weeks before the Budget this was a well-timed intervention, given that Stevens could have made these remarks in any of the numerous speeches he has given this year. You can just imagine shadow health secretary Jon Ashworth rewriting his attacks for next week's health questions as Stevens spoke. Stevens' speech was notably trailed beforehand with excerpts of his comments on Brexit, explicitly calling for the infamous £350m for the NHS to be coughed up. Strikingly, he claimed that “trust in democratic politics” would be damaged if not - you don’t often hear the head of Ofsted or the Environment Agency speaking like this. He went further though, sounding like Theresa May in parts when describing the health service as a solution to the "economic dislocation" and social injustices that led to the referendum result. This was a subtle reminder to the Government of the wider ramifications of the continued spending levels for the health service. The speech came directly after Jeremy Hunt's and Stevens dodged the question of whether he had run his remarks past the Department of Health first. Hunt himself knew the audience in the room and made all the right noises, hinting at the potential for additional money to fund a pay increase in return for improved staff productivity. But it was clear that Stevens was calling for far more, indeed calling this quid pro quo an “own goal of the first magnitude” on the day that Hunt was appearing before the Health Select Committee in October. This is a man with a strong sense of political timing and a capacity to score a few column inches that would make some cabinet ministers envious. In fact, with the focus on the £350m pledge, the warnings of an additional 1m people on the NHS waiting list and slower improvements in cancer, it seemed like Stevens was addressing the public’s main concerns for the NHS, rather than the clinicians and managers in the room. Whether this will make any difference on Budget Day is another matter though. It seems unlikely that Hunt would hint during his speech on the potential for new funding and be left with nothing to show for it. However, despite months of intense criticism last winter and repeated calls for a long-term solution to NHS funding, the Government only pledged a few billion for social care and some capital investment in the Spring Budget. If Philip Hammond didn't take bolder action then, will he now? Certainly, the Government will seek to get its funding promises (or its rebuttals to Labour) in early this time as the NHS “winter crisis”, like Christmas adverts, seems to come around sooner every year. Stevens spoke of the difficult choices the Chancellor was facing and depending on your point of view, his speech just made a tricky Budget even harder.