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Treasury leaves NHS waiting on crucial staffing budgets

Published on: 27 Oct 2021

Government has failed to confirm education and training budgets for next year, despite repeated warnings by officials of the potential damage to delivering key asks, HSJ has learned.

The government’s three-year spending review documents published today said its health settlement will mean it “will keep building a bigger, better trained NHS workforce”.

However, it has not published any annual budget details for Health Education England, which funds education and training, meaning it cannot plan beyond March. Other revenue budgets including NHS England have been set to 2024.

In response to questions from HSJ, the Treasury initially said this afternoon it would work with the Department of Health and Social Care and Health Education England to develop detailed workforce spending plans in the coming months. HMT later told HSJ the HEE budget would be decided in due course.

This is despite repeated warnings from senior officials that confirmation of sufficient spending growth for HEE is urgently needed.

HSJ has learned the HEE board wrote to Sajid Javid in recent weeks, in the run-up to the Budget, to underline that failure to confirm its budget with sufficient spending would undermine government commitments to increase staffing, and objectives for NHS covid recovery. For 2021-22 the HEE budget was not confirmed until much later, shortly before 1 April, which caused problems with planning and delivery. 

And last week NHSE medical director Professor Steve Powis warned it was “absolutely critical” HEE received a settlement in the Budget to enable it to increase staff supply.

The Budget documents published today said the funding would underpin “training of some of the biggest undergraduate intakes of medical students and nurses ever… continuing to support a strong pipeline of new midwives and allied health professionals… [and] reaffirming the government’s existing commitments for 50,000 more nurses and 50 million more primary care appointments”.

Officials remain hopeful the budget will be confirmed in the near future, and believe positive talks are ongoing with NHS England (which has funded some training via HEE in recent years) and with DHSC.

However, no details have been confirmed so far, and NHS leaders have expressed major concerns.

Saffron Cordery, deputy chief executive of NHS Providers, said of the omission: “Trust leaders will be disappointed and frustrated that there is no confirmed multi-year increase in Health Education England’s NHS education and training budget.

“Workforce shortages and the resulting unsustainable workload on existing NHS staff are currently the health service’s biggest problem. They can only be tackled with a robust long-term workforce plan and increased longer term investment in workforce expansion, education and training, none of which are currently in place.”

Danny Mortimer, chief executive of NHS Employers, said a “strong and supported NHS workforce is needed”.

HEE finance director Calum Pallister told HSJ: “A committed, compassionate and qualified workforce is the bedrock of delivery now and for future improvement in health and care. Final details of HEE’s allocation for 2022-23 and the workforce investments it will fund are still being discussed.

”DHSC have indicated HEE’s budget will grow year on year over the Spending Review period as a result of this settlement.”

£10.3bn capital uplift confirmed

The government is set to broadly meet the real-terms uplift of NHS capital spending which the sector called for ahead of the Spending Review.

Earlier this month the NHS Confederation joined the Health Foundation in calling for the Department of Health and Social Care’s capital budget to be increased to £10.3bn by 2024-25.

Budget documents reveal the DHSC’s capital budget will be £11.2bn in 2024-25, which – excluding inflation – equates to around £10.5bn compared with today’s value.

The DHSC’s capital budget will rise from £9.4bn this year to £10.6bn in 2022-23. It will then drop by £200m in 2023-24 before rising to £11.2bn in 2024-25.

Danny Mortimer, deputy CEO of NHS Confederation, said health leaders were “grateful the chancellor has listened to their pleas” and added that the “significant increase in capital funding” would help the NHS reduce waiting lists and health inequalities, and contribute to the net zero target.

However, Nigel Edwards, CEO of the Nuffield Trust, warned the ambition to reduce waiting lists “on top of upgrading hospitals, increased construction costs and repairing £9.2bn worth of urgent maintenance after decades of raided capital budgets will place a heavy draw on these funds”.