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NHS Long Term Plan funding for primary care at risk, says Health Foundation

The funding for mental health, primary and community care set aside as part of the NHS Long Term Plan is at risk without improvements in acute hospital care, the Health Foundation has warned in a report released this week.  

The planned £20.6bn increase in the NHS England budget alone cannot guarantee the plan’s success, highlighted the analysis. It concluded there is a ‘real risk’ of funding being diverted to acute and specialist hospitals if demand for hospital care is not reduced. 

The research said that the £20.6bn will come in the form of modest initial increases, followed by the largest injection in 2023/24, which is not what was announced in the settlement last summer. This means it will be harder for the NHS to support a period of initial investment in care outside of hospitals and reduce demand for hospital services. 

As a result, the Health Foundation report predicted that there will likely be increased waiting times and the planned funds for improvements in primary and community may be diverted to struggling hospitals. 

In tandem with the Health Foundation report, the NHS Confederation released a separate survey of 67 leaders from trusts, CCGs and ICSs about their thoughts on the NHS Long Term Plan. It found that only one in four NHS leaders believe their local health systems will be able to reduce the demand for acute care by the amount necessitated by the plan.

The Health Foundation report endorsed this view from health service leaders, finding that the additional funding available for acute and specialist care promised as part of the plan was not enough - it would account for a 2.3% rise in activity per year, but not the projected 2.7% needed by 2023/24 just to keep in pace with demand.  

As investment in mental health, primary and community care will not instantaneously reduce avoidable hospital admissions, the NHS is must perform a ‘juggling act’ to moderate the continuing demand for acute care, said the report. 

It continued: ‘If the rate of growth in demand for hospital care can’t be reduced, there is a real risk that the planned additional investment in mental health, and primary and community care will not materialise and, once again, funding will be diverted to acute and specialist hospitals.’ 

The Health Foundation report also suggests that the success or failure of the plan depends on whether the Government commits to urgent investment in the budget for Department of Health and Social Care, which the report said must increase by 4.1% to deliver the higher quality services outlined in the long term plan.

As part of the budget, public health will need £1.5bn extra funding per year by 2023/24 to help prevent illness and encourage healthier behaviours, following a £850m reduction in real terms since 2014/15.  

In addition, it must significantly increase funding for social care and capital infrastructure, alongside at least £900m additional investment per year in Health Education England by 2023/24 as outlined in a previous joint report from The Health Foundation and The King’s Fund.   

But whether this funding will be provided is dependent on the 2019 spending review, which has been delayed for an unspecificed length of time in part due to prime minister Theresa May’s resignation and the lack of an EU-withdrawal agreement. 

Health Foundation chief executive Dr Jennifer Dixon said policy makers must accept there is ‘urgent unfinished business’ if the NHS is committed to delivering the plan and imroving patient care. 

She continued: ‘The NHS is being seriously hampered in efforts to move forward. How can any industry significantly boost productivity without investing in staff training, technology and kit?  

‘The new government needs to honour last year’s promises to set out long-term funding for public health, capital investment, workforce training and social care, and ensure they receive sufficient funding to support the long term plan ambitions.’ 

Niall Dickson, chief executive of NHS Confederation said the survey indicates that NHS leaders are ‘optimistic’ about the future. 

He continued: ‘But they also have serious concerns. They face crippling staff vacancies, rising demand for care, lack of investment in buildings and equipment, and the drastic cuts to social care and public health that are fuelling extra demand on A&E and other frontline NHS services.  

‘Failure to address this in the next spending review will put the ambitions of the NHS plan in jeopardy, and patients will not feel the full benefits of the extra £20 billion of funding.’