Javid: No increase in NHS funding to address workforce needs

Any investment to increase NHS staffing levels recommended by the forthcoming long-term workforce plan will need to be funded from within the service’s existing budget, Sajid Javid revealed today.

The health and social care secretary made the admission when answering questions after a wide-ranging speech  on NHS reform. 

The speech included few new announcements but Mr Javid did say he wanted trusts with a strong track record to establish “partnerships for reform” to help others, and criticised current NHS leadership development as “unstructured and unsupported’.

Mr Javid confirmed that he had commissioned NHS England and Health Education England to develop a workforce plan  and that it would examine both short and long-term supply and demand.

Many NHS leaders believethe service requires more money  to retain existing staff, and to attract and train more in future years. The Treasury has been criticised for resisting repeated attempts in recent years to develop and publish funded plans.

Responding to the spending review in October, the NHS Confederation said it was “difficult to see how benefits will be delivered without a fully funded workforce plan to address shortages”.

Asked whether the new workforce plan would be fully funded, Mr Javid said: “Obviously I don’t know the outcome of the plan yet, but whatever comes out of that plan we would work to meet from existing budgets.

“The link [between] that plan and the other things I was talking about today is that so many of these measures will eventually go to reduce workforce pressure.

”So if we can prevent more people from getting avoidable illnesses in the first place, then clearly there’s less pressure on the workforce. If we can digitise and use data more and more quickly, that can help the workforce to treat more people than otherwise by having those tools at their disposal, if we can use the app [in new ways].

“So I look forward to that plan [and] it is really important to do this long-term working. But in terms of the cost of meeting that plan, that will come from existing budgets.”

National health budgets have been announced until 2024-25 so longer term elements of workforce planning, such as training additional new clinical staff, and their future cost implications, are likely to stretch beyond it and could be funded in future spending reviews. Initial training costs could land sooner, however. Mr Javid said he wanted the new plan within a year.

Elsewhere, Mr Javid said an early recommendation of his Messenger review of leadership – due to report at the end of this month – was for better development of NHS leaders. He said: “There is some phenomenal leadership in the NHS, but investment in it is often unstructured and unsupported.

“I want to create formal systems that can embed excellence and rigour into the NHS, so our country’s greatest institution has the leadership it deserves for decades to come.”

The speech did not include any mention of either “academy trusts”, ormoving GPs into NHS employment, which have been trailed in recent months. On the latter Mr Javid said he would wait for the conclusion of the Fuller review, on the former he said he planned to promote for “partnerships for reform”, which would include giving stronger trusts more freedoms.

He added that he would be “setting out [in future] how to take this forward, and what we will be focusing on is that those trusts that have a very strong track record, that are highly rated, they will have not just more freedoms for themselves, they will have the opportunity to work in partnership with more challenging trusts, and help them with everything from executive management right down to patient care”.

He continued: “I want to explore what trusts working in such partnerships could do with greater freedoms and see what else we can do to help them share so much of the brilliant work they’re already doing, so more patients can benefit from improved performance and access to services.”

As examples of successful “reform partnerships” he cited the link-up between the three south London mental health trusts, the south west London elective orthopaedic centre, and Somerset, where a merger has brought mental health, community and acute care in a single trust, with further plans to merge with a neighbouring acute which operates several GP practices.

Other commitments mentioned in the speech included:

• Further expansion of personalised care, including ”exploring the extension of legal rights to enable significantly more” personal health budgets, and “more people to have integrated health and social care budgets to better join up care for individuals”.
• Calculating a baseline of how much health and care spending is currently “preventative”, and look at how it could be increased.
• Requiring NHS England and integrated care systems “to commit to joint delivery plans to reduce the biggest preventable diseases – starting with cardiovascular disease, but in time, expanding to include diabetes, cancer, and poor mental health”.
• To “push the entire health and care system harder on the prevention of cardiovascular disease”, including reducing mortality, and in inequalities whereby “premature deaths from cardiovascular disease are four-times higher in the most deprived communities compared to the least”.