Coronavirus has driven a coach and horses through the NHS budget. We badly need more funding

The NHS is staring down the barrel of rising Covid-19 infections, lengthening waiting times and a workforce that is exhausted. As we head into the winter, the stakes could not be higher.

The good news is that we have learned much about how to manage the virus and are better prepared second time round. Despite dire predictions that it would not cope, the NHS has not only managed a huge wave of Covid-19 patients but also continued to treat millions not infected with the virus.

But we know the strain will continue to be felt across the country, and that’s why the government’s spending review next month is a critical milestone in ensuring the NHS and social care services get the support they need to safeguard the public.

Compared to other public services, the NHS has already got a relatively generous budget of £20.5bn up until 2023. But this settlement was only ever enough to stabilise services after a decade of austerity in the 2010s.

Starving the NHS of funding for so long led to lengthening waiting times. Going into the pandemic, the NHS had not met the four-hour waiting time for A&E for five years, while only one in three children and young people with mental health needs received treatment and support. On top of this, the NHS continues to suffer from under-staffing, with around 90,000 roles unfilled.

All of this has been exacerbated by Covid-19, with the pandemic driving a coach and horses through the NHS’s budget.

Back in March, chancellor Rishi Sunak promised the NHS would get “whatever resources it needs” to support the service through the pandemic. But we are already seeing that commitment fraying at the seams. NHS leaders up and down the country don’t have the funding they need to manage services to coronavirus patients, while also eating into the backlog of treatment that has built up. Some estimates say the funding gap could be as much as £1bn across the NHS in England.

The government has provided additional funding, but it is not enough. Put simply, we need a reassessment of the funding and resources the NHS needs to cope with what is the most unprecedented challenge of our lifetimes.

What should we expect in next month’s spending review? Firstly, we know the chancellor has downgraded the review from a three-year settlement to one year. However, he has committed to “protect” the NHS budget.

As ever, the devil will be in the detail and we are waiting to see if he will deal with key areas of unfinished business that the government had promised to address in the review.

Top of the list is making sure the government invests to address the patient waits in all settings caused by the pandemic and the necessary money to upgrade old buildings and invest in digital technology. Current plans in this area mainly focus on hospitals, but we know mental health, community services and GP premises are also badly in need of upgrading.

The chancellor must also invest in training and education budgets if we are to have any hope of reducing NHS vacancies. This is a manifesto commitment but won’t be achievable without sustained investment and is the long-term key to the wellbeing of NHS teams.

And the chancellor must also reverse some previous wrongs, notably on social care and public health which have been neglected for far too long. They both need extra funding in both the short and long-term, and the government needs – finally – to be true to its word when it said it would “fix social care”.

This is a moment of truth for the government and its stewardship of the NHS. Frontline NHS leaders and their teams will continue to do everything they can to manage coronavirus, while maintaining access to vital mental health, cancer and other services for their non-covid patients. But they need funding and support from the government and, next month, all eyes will be on the chancellor to provide the answers.

Danny Mortimer is chief executive of the NHS Confederation

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