RESIST THE BREAKUP OF THE NHS THROUGH PRIVATISATION AND CUTS!
FOR COMING EVENTS, MEETINGS AND BLOG POSTS SEE BELOW. Following the 2015 election there was an upsurge in people wanting to know how they can help support the NHS during the next 5 years. Sheffield voted heavily for pro NHS parties.
Now we are faced with the NHS trying to manage within the government's constrained budget by reconfigurations and cuts under the imposition of a requirement for local Sustainability and Transformation Plans.
We held a public meeting on 4th July 2016 to celebrate the NHS anniversary, discuss these plans, the implications for privatisation in South Yorkshire and North Derbyshire and the consequences of the EU referendum result.
For a view on the EU referendum see our post for 19th June
In March we held a successful workshop Taking Back Our NHS
The Conservatives continue to be in major difficulties carrying out their promises for the NHS, especially after making a totem of the impracticable 7 day NHS proposal. Many of the struggles against cuts and privatisation are likely to be at local level - especially as the Tories slide devolution through. However major staff disputes remain national.
For more national information see Keep Our NHS Public at http://keepournhspublic.com
Cartoon by Samantha Galbraith @sgalbraith47
We have supported the Junior Doctors throughout their action because we felt they were being unfairly treated and were being treated as the advance guard for Hunt's uncosted, unfunded and misconceived ambition for a 7 day NHS. (For one of our supporter's views at the beginning of the dispute see this column in the Sheffield Star http://tinyurl.com/oo8qoc3)
For a view on the EU referendum see our post for 19th June
For our questions to 2015 General Election candidates and canvassers about the NHS see our website campaign page
We post information and comments from SSONHS on a regular basis. Please use this site to post comments, leave information about cuts , provide feedback and discuss content from the main website http://www.sheffieldsaveournhs.co.uk/. You can also suggest topics and post anything else to do with the Health and Social Care Act and its consequences.
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Updated : Sept 2016
New Posts: Sept 2016
Even the Tories now admit that Lansley's NHS reforms were a huge mistake. Lansley himself disappeared from view until Cameron's recent attempt to hoist him into leading UN humanitarian initiatives - which was rejected after national and international lobbying against him.
In the aftermath of the election the government had to try and find a more permanent solution to the contradictions of the Coalition legislation and the funding shortages of the NHS. In 2014-15 Hospitals and even CCGs were being bailed out under the guise of winter pressure money - itself raided from other NHS budgets. This year many more have posted risk of 'financial failure' (an artificial definition). George Osborne was forced to bring forward some of the funding promised to the NHS in the Tory manifesto but it is already mostly spent and the Department of Health has had to go cap in hand to the Treasury for a £205m bailout.
As Trusts reach their limits for 'efficiency' savings Hunt is still pursuing his often impractical promise of 7 day working. Junior Doctors have been the first to pay the price. Meanwhile the costs of the cuts elsewhere, including social care, will rebound on the NHS.
More privatisations (often disguised as efficiency savings or rescues from financial failure) will be on the way plus more talk about charges in order to reduce demand.
Staff means of resistance may be hindered by new Tory legislation about industrial action.
Devolution proposals may mean another way in which the government can slough off responsibility for cuts in the NHS and associated Council budgets.
Now, more than ever, the NHS needs your active support to remain a public service.
Local NHS leaders in Sheffield are not trying to spearhead privatisation and have decided to make a major recommission for musculoskeletal service by working with the main local NHS Hospital Trust as prime provider rather than going to tender. Up to now the Sheffield health economy has been reasonably stable but national cuts including the tariff changes for acute hospitals and the 'equalisation' of GP funding are beginning to bite.
South Yorkshire has been among the big losers as both health and local authority budgets are disproportionately reduced because of the removal or marginalisation of allocations for inequality and deprivation, thus benefiting richer areas in the South of England. Yet there is considerable local interest in devolution despite the potentially devastating effect this could have on local services.
Yorkshire and Derbyshire
Local interest in campaigning for the NHS includes active groups in Leeds, Bradford, Hull, Harrogate, York, Barnsley, Chesterfield, Derby and Nottingham, as well as our own group in Sheffield which has campaigned both locally and nationally against the Health and Social Care Bill and continues to speak up for a publicly owned and accountable NHS at all opportunities.
THE NHS IS NOT KILLED OFF YET. Campaigning does work - For example the strong opposition to Clause 119 of the Care Bill forced the government to retreat on at least some of its proposed restrictions to public consultation on hospital changes if a nearby hospital is placed in administration. Local action, as in Lewisham, can still force commissioners to think again about cutting valued services.
SSONHS Planning and Information Meeting
Monday 3rd October 2016 6pm
United Reform Church, Chapel Walk/Norfolk St S1
22nd November SSONHS Festival of Debate event Why is the NHS Under so much pressure? 7pm prompt. Quaker Meeting House S1
SSONHS planning and information meetings are generally on the first Monday of the month, except for bank holidays. They are usually at 6pm at the United Reform Church.
Taking Back Our NHS SSONHS workshop
Saturday 12th March 2016, 10am - 2pm
Campaigning for GP practices at risk of closure
2nd July Successful SSONHS public meeting addressed by Ray Tallis and speakers from Devonshire Green and Unison.
2nd May SSONHS stall in city centre from 11.30 Come and see us.The 38 degrees ambulance will also be in Surrey Street at 12pm and conveying the 38 degrees petitions to local Hallam candidates at Wesley Hall in Crookes for 3pm.
25th April - March through Sheffield Hallam, with the People's NHS and 38 degrees
28th February 38 degrees petitioning around Sheffield http://www.thestar.co.uk/news/health/local-health/campaigners-take-to-sheffield-streets-in-fight-to-save-nhs-1-7132981
22nd November Leafleting in Sheffield City Centre from 12.00 pm in support of the NHS strikers. For A5 and A4 copies of the leaflet which has more information on it see the Campaigns Page at our website
24th November NHS picket lines from 7am to 11am. Rallies at the Hallamshire and Northern General (Herries Road) at 10 am.
24th JULY 2014 Public Meeting jointly with Sheffield Medsin
We were proud to support the Jarrow to London march for the NHS, organised by Darlington Mums passing through Sheffield on August Bank Holiday Monday. http://999callfornhs.org.uk/ Thanks to everyone for helping and joining in.
Is our NHS really in crisis? Behind the headlines and soundbites
Panel discussion led by GPs and health experts from the NHS and universities.
For past activities see our website www.sheffieldsaveournhs.co.uk
Sunday, 25 September 2016
The STPs are unequivocally about getting the NHS to make local decisions about how to manage within the very tight and effectively reducing Government budget for the NHS. Nervous about this, NHS England placed a ban on public involvement during the preparation of the plans. In many areas (including West Yorkshire) they involve hospital closures. Some London Councils have refused to sign up to STPs where they involve the closure of popular facilities and the organisation Health Campaigns Together is calling on all Councils to refuse to sign up to STPs where they involve significant closures.
Some details of the Sheffield Plan will be made available on 29th Sept but local statements suggest that the process is currently more fluid than the early proclamations from NHS England anticipated. Although the plans are scheduled for implementation from April 2017 there will have to be formal public consultation from October. In Sheffield this will include sub-regional consulation on new proposals for hyper-acute stroke and paediatric surgery services - separate from but linked to the STP - and any changes deemed 'significant' by Sheffield CCG on Urgent and Emergency Care. the changes to stroke and paediatric services will involve some services ceasing in some centres (e.g. Barnsley and Rotherham) in order to reinforce/improve the regional services from the centres regarded as stronger (including Sheffield. This will have implications for income, viability and capacity in all local hospitals and the consultation will need to be vigorously addressed.
We will post further updates as we get news.
Wednesday, 29 June 2016
The EU Leave campaign made a deliberate point of promising extra money for the NHS. The extent of the pledge was quickly revealed to be a lie and, indeed, post referendum, has already been retreated from by the likes of Nigel Farage. Nevertheless comments from the public both before and after referendum day suggested that it stuck in the memory and influenced people’s votes.
Whatever happens to the UK’s relationship with the EU after the vote in favour of Leave, the current government's austerity programme has placed the NHS in dire trouble and it is now issuing new threats to public spending. Goerge Osborne warned that even his so-called protection for the NHS budget was unlikely to be guaranteed. Starved of resources, haemorrhaging clinical staff, and facing continually rising expectations, the NHS faces new threats of further cuts because of growing economic weakness, rising inflation as a result of currency fluctuation and the likely diminution of the 52000 EU immigrant staff who help to keep services meeting patient need. As budgets get tighter national and local NHS leaders are being forced into ever more contortions to keep the service going - the latest being so-called Sustainability and Transformation Plans, in our case covering the whole of South Yorkshire and Bassetlaw. In many parts of the country these plans introduce cuts and closures and are already subject to challenge.
In the General Election our area voted overwhelmingly for pro-NHS candidates but in the referendum it voted narrowly for Leave. Few in Sheffield want to see the NHS collapse so we have a collective responsibility to ensure that what we value about our system lives on. We, the public, NHS patients and NHS staff, whether we are Remainers or Brexiters, need to care for the NHS both in the demands we must make of decision makers in all parts of the political spectrum and in the way in which we use it. Otherwise. before very long, we will find ourselves faced with an increasing spread of charges and the collapse of many parts of the system into private hands with no sense of responsibility to society at large. We've already seen the mess which has been left in places like Nottingham, Cambridgeshire and Cornwall when that happens. Sheffield Save Our NHS will be continuing to campaign both locally and in partnership with others in Yorkshire and the rest of the country to keep the NHS as a public provider of quality universal health care.
Come to our meeting on 4th July at the United Reform Church (6.30 for 7pm) to celebrate the 68th anniversary of the NHS, to hear about developments across Yorkshire, and to plan how best to campaign for the NHS in the future.
Sunday, 19 June 2016
Whatever side you are on in the referendum debate the NHS should not in itself be a crunch issue although broader health considerations may be. The NHS is not directly relevant to the basic arguments for or against EU membership especially as the debate becomes increasingly polarised between those who consider they have a lot to lose and those voters who feel they have very little left to lose.
The basic trope of the Leave campaign in relation to the NHS is that more money will be available for the NHS if we leave and that pressure on services will be reduced because there will be less immigration. Two Tories have commented on the finance issue: Dr Sarah Wollaston the GP who was part of the Leave campaign, has changed sides because she could not justify the claim that £350billion is paid to the EU, let alone that a significant part of this would be available for the NHS. Also speaking about the NHS last week, John Major, ex Tory PM, told Andrew Marr on the BBC that "Michael Gove wanted to privatise it, Boris wanted to charge people for using it and Iain Duncan Smith wanted a social insurance system. The NHS is about as safe with them as a pet hamster would be with a hungry python". As for immigration, yes there are pressures on the NHS just as there are pressures on the Spanish health service because of elderly Brit expatriates. These might change slightly if Brexit secured some change in migration rules but would not necessarily be hugely different especially if we remained in the single market. The threat to the many non UK nationals working in the NHS would be significantly undermining and an extension to the threats faced by non-UK NHS staff earning under £18000 under the current Tory system. We have also been told about the importance of EU membership for collaboration on medical and public health research.
The Remain campaign claim that the Brexit would lead to economic difficulties and confusion for the economy as a whole and this, as Simon Stevens (head of NHS England) has warned, could seriously affect the NHS both short and long term. The NHS is highly vulnerable right now and the head of NHS Improvement has already said that the NHS will be unable to meet its national undertaking to break even this financial year. However the dire general warnings being uttered by lead Remain campaigners and European leaders seem much too catastrophic. Faced with Brexit more bilateral or alternative agreements could and would be drawn up to cover such issues as EHIC although some of the arrangements for elective treatment in EU countries currently available for NHS patients are likely to become unavailable and this would create more demand on UK services. Nevertheless Brexit supporters who are concerned for the NHS have to weigh up whether the longish period of serious economic and political uncertainty which will follow any vote, together with the consequent high level of threat to public sector spending and an NHS which is already over-stretched, is worth the risk against whatever they think will be gained. It is quite possible that the administrative strain of leaving the EU could be at least as stressful for the NHS as Lansley's Act.
Broader health issues and the consequent effects on the NHS are also relevant. We already have austerity and further economic uncertainty will, in the short term at any rate, affect jobs and the national income. Some of the issues are listed in a BMJ article but the links are behind a pay wall. Some medical opinion is summarised by The Independent here. Most medical opinion is in the Remain camp. The EU has taken significant public health initiatives although these are constrained by the lumbering nature of the way in which decisions are taken. Would the sort of UK government or regime which might follow a Brexit vote be likely to give equal support to public health issues, environmental considerations or even human rights given that a prime argument for leaving is deregulation?
Against this it is perfectly possible to argue that taking back responsibility for decision making into UK hands would mean that credit or blame for outcomes, for instance on the NHS, could be squarely put where it belongs instead of using the EU as scapegoat or smokescreen. Some financiers fear that Brexit could give space for 'madcap left ideas' if EU restrictions on state aid to industries are withdrawn (although other EU countries seem to have found ways to provide state support where necessary/desired). One positive outcome of the referendum arguments is the present government's agreement to formally exclude the NHS from TTIP - though the real worth of this assurance is still be tested. Brexit may of course eventually exempt the UK from EU competition laws (though these might still apply, at least partially, in a single market) but what would be the likelihood of a UK government taking an even more pro-competition stance? Business leaders who favour Brexit are overwhelmingly taking a neoliberal free market line.
If this piece is read as being pro-Remain, it is largely because of the misleading claims about the NHS being made by the Leave campaign and the distrust this generates. Campaigners report doorstep opinion that the Brexit campaign is more pro NHS which, as the quotes above suggest, is absolutely untrue.
If we remain in the EU, we know what the general climate is. If we leave then we will have to fight even harder to try and retain the public services we value. For some this may in the long term be a more attractive scenario because it can be argued to favour self-organisation. For others it can only create serious alarm.
Sunday, 24 April 2016
As the Junior Doctors begin to vote on the contract offer, opinion remains split. There are plenty of reasons for rejecting the offer but many doctors feel they have gone as far as they can and want to get on with their training/careers. Another result for Hunt - divide the opposition. Most are agreed that the current offer is a massive improvement on the original proposals and also on the March offer. There are some significant concessions by the junior doctors (for example the loss of increments) and other technical worries remain partly because of Hunt's insistence on the 7 day concept and his neutral cost envelope. But the main concern is the effect on staffing and recruitment as well as the loss of momentum in the huge wave of public support to preserve the NHS. The rejecters say "The contract on offer will not fix the recruitment and retention crisis. It is not going to help trainees on rotas with less than 50% fill rates such as GP and Core Medical Training. It is not going to help with the cost of living crisis as inflation continues to outstrip pay. It is not going to attract trainees back from abroad and encourage people to stay as a doctor in the NHS. It will drive LTFT [doctors in less than full-time training] out of medical and surgical specialties and possibly out of medicine as a career, despite the best efforts of our negotiators to prevent that. It will require a constant fight with management in order to be paid for the work we do, with no independent oversight, without concrete safeguards that a hospital has any legal duty to honour." See here
We were asked by the Sheffield Star to submit a short article for possible publication in a feature on the strikes on 26th April. This is what we wrote.
"Talk to almost any junior doctor and you’ll immediately sense their anxiety not just about their own future but about the whole NHS. Jeremy Hunt’s insistence on trying to stretch the NHS while cutting its funding is squeezing staff at all levels beyond endurance. As numbers fall, junior doctors find themselves rostered to provide more and more extra cover with less help, often in unfamiliar surroundings and knowing that any mistake will be jumped on. In the 2015 NHS Staff Survey only 31% of staff agreed that there are enough staff for them to do their job properly.
We already have fewer doctors per head than most other European countries. 80% of junior doctors work unpaid overtime, often 11 hours a week. In 2008, 22% of doctors using the official ‘sick doctor service’ were aged under 35 but by 2015 that number was 54%. In 5 years newly qualified doctors joining NHS training schemes have reduced from 71% to 52%. Many trainees are planning gap years from this August because the proposed contract is the last straw. It also discriminates against women doctors.
Hunt’s 7 day service plan is based on misleading statistics and an ill-thought-out manifesto commitment totally derailed by his government’s austerity programme. The NHS will be less safe and possibly not even sustainable. Despite considerable progress in negotiations, the disagreement about Saturday working is less about pay than about clinical staff being able to retain enough control over their working lives to ensure they can make decisions and carry out treatments safely. If the doctors lose, nurses and other clinical staff will be next. We call on Sir Andrew Cash at STHFT not to implement the contract locally.
Without junior doctors our health service will collapse. Nobody wants these strikes but any short term safety risks are outweighed by the longer term danger of system collapse. Not all doctors’ strikes have been for the NHS but this one definitely is. They need our support."
Although several of us are away during the week, we shall be supporting the pickets at the major hospitals and the rally in Barkers Pool at 1pm on 27th April.
Thursday, 18 February 2016
Sheffield Save Our NHS will be hosting a half day event of information, discussion and campaign planning.
Taking Back Our NHS
Saturday 12th March 2016, 10am - 2pm
The Roco, 342 Glossop Road, Sheffield. S10 2HW
Keynote speaker Dr David Wrigley, Carnforth GP, Member of BMA Council and GP Committee and longstanding KONP activist. Plus regional and local speakers, who will cover the situation in Sheffield, the parliamentary NHS Bill to reinstate the NHS, and the Junior Doctors' dispute; followed by guided discussion and action planning.
The NHS is reeling under the pressure of the new market structures and the financial restrictions introduced by the 2010-15 Coalition government and reinforced by the current Conservative government. What is the impact in Sheffield and what can we do about it?
The Junior Doctors dispute has shone a light on the discontent felt about the government's agenda by many NHS staff and provided a focus for showing support for the NHS. Find out the latest in the dispute and what can be done to build solidarity.
This event is part of national action called by Keep our NHS Public to mark the second Parliamentary reading on March 11th of the National Health Service Bill, introduced by Caroline Lucas MP (Green Party) and co-sponsored by the Labour leader Jeremy Corbyn MP.
All welcome to come along and contribute Refreshments and low cost lunch available.
Register for the event at Eventbrite.co.uk,
or email firstname.lastname@example.org
Pre-registration would be helpful to us but you can just turn up on the day
Wednesday, 10 February 2016
After many false hopes of potential settlement (including Hunt's potential departure following the Brexit vote)the junior doctors voted not to accept the new deal and eventually decided that escalating the dispute would be the only way forward. Reluctantly they posted notice of a rolling programme of 5 day strikes (daytime only) starting in September, but feedback from members and senior doctors soon revealed that the NHS would be too fragile to cope and patient safety might well be compromised. The first strike was called off and on 24th Sept a newly elected junior doctors leadership (including several radical names) decided to suspend the proposed actions entirely while not accepting imposition of the document. This will cause difficulties for junior doctors as new rotas are introduced next month and the JD leadership is likely to propose a different series of actions. A High Court judgement on the junior doctor's challenge to the new contract as the result of Hunt acting beyond his remit and irrationally is expected on the 28th Sept. The Junior Doctors' statement is on the BMA website.
Update 18/02/16 Following the strike on 10th February Hunt announced that he would be imposing the contract. In a typical NHS management muddle a number of leading NHS Trust executives including Sir Andrew Cash from Sheffield Teaching Hospitals were cited as supporting Hunt. However many of them, including Sir Andrew, notified that while they regarded the revised contract as fair and reasonable they did not support its imposition. Following reports that the imposition was not binding on Trusts, Health Education England which is now in charge of national training schemes announced that Trusts which did not impose the contract could be fined. Junior doctors are considering their positions while senior doctors have rallied to their support. This is a huge crisis for the NHS.
10/02/16 Both the Independent and the Guardian have reported that a provisional agreement between NHS Employers and the BMA has been personally vetoed by Jeremy Hunt. The crux seems to be around the description of Saturdays. Jeremy Hunt did not turn up to Parliament on Monday to answer an urgent health question, leaving it to his sidekick Ben Gummer. The interesting parliamentary exchanges can be read here.
The new chief negotiator's letters to junior doctors and to Jeremy Hunt can be accessed here. Note David Dalton's references to the crisis in morale among junior doctors (not to mention other NHS staff groups) and figures published today suggesting that fewer and fewer doctors finishing training will stay in the NHS.
This is clearly a strike which did not need to happen and the fault appears to lie firmly with the Government. As well as failing with this particular contract negotiation, they continue to undermine the NHS as a whole.
Finally a report just out from the National Audit Office, the independent spending watchdog, firmly criticises NHS workforce planning and says it is often driven by the need to make cash savings rather than clinical need. It says:
there is a 5.9% reported staffing shortfall in 2014, equating to some 50,000 clinical staff.
Across the health system as a whole, there are shortcomings in how the supply of clinical staff is managed, in terms of both planning the future workforce and meeting the current demand for staff.
"Trusts’ workforce plans appear to be influenced as much by meeting efficiency targets as by staffing need. Our evidence indicates that trusts’ workforce plans are often driven by the financial plans that they prepare for the NHS Trust Development Authority or Monitor. These plans envisage significant recurrent pay savings. Between 2012-13 and 2015-16, trusts planned to make recurrent pay savings of around £1 billion each year, although actual savings consistently fell well short of this amount. By focusing on efficiency targets when balancing financial sustainability and service requirements, trusts risk understating their true staff needs. This in turn could result in Health Education England commissioning too few places to train new staff. At trust level, it may also lead to gaps in staffing or additional costs from using more expensive temporary staff to address shortfalls.
All key health policies and guidance should explicitly consider the workforce implications. Past developments have not fully assessed how the necessary staff will be made available and funded. When major changes to services are proposed, such as the ‘7-day NHS’, the various national oversight bodies – including the Department, NHS England, NHS Improvement, the Care Quality Commission and the National Institute for Health and Care Excellence – need to work together to understand the staffing implications and financial impact.
The Department and Health Education England should review the funding arrangements for training clinical staff. The review should involve evaluating the effect of current and planned funding arrangements for higher education institutions, clinical placements and students. Specifically, they should ensure that the right incentives, including financial reimbursements, are in place to supply sufficient staff with the right skills in the right locations."
In these circumstances - more and more responsibility, stretched out over more and more time, and with less and less help - is it any wonder that Junior Doctors feel that they are being "hung out to dry"?
Monday, 11 January 2016
Hunt is trying to introduce a 7 day NHS on the basis of ropey evidence and within a tight financial envelope which will not bear the strain. The 7 day NHS may be a manifesto pledge but even manifestos have to be treated with realism. The public does want proper safeguarding of their health, both within hospital and outside, but there are few signs that it wants or expects the NHS as a whole to function fully for 7 days, especially if this eventually means a dilution of services during the week.
Hunt wants to put doctors working conditions firmly in the grasp of the management of hospital Trusts, many of which are either in desperate financial straits or retain control only by squeezing their staff till they have no energy left. Doctors want to retain some control over their own conditions and not find that they are being used as elastoplast to cover up management inadequacies, shortages of staff, and financial crises. While it is reasonable to ask staff help organisations adapt to new conditions, it is not reasonable to force staff on whose decisions lives depend, to become overstretched and undervalued. Doctors are striking against what for many would be a cut in pay and a worsening in conditions. They are also striking because the government position on safety both for patients and practitioners lacks both detail and conviction.
Any inconvenience to patients is outweighed by the overall consequences for the NHS if the doctors lose their action and Hunt imposes a new contract. It is vital that the public speaks out in favour of the doctors and rejects the smears and insinuations being peddled by the government and much of the right wing press.
Tuesday, 24 November 2015
The Government is still claiming that this will pay for a 7 day NHS (which hardly anyone wants - e.g. 2/3 of patients just surveyed by the Royal College of GPs say the government should improve existing services before stretching them) and might even allow Hunt some margin to settle with the Junior Doctors. However a good chunk of the funding will be swallowed up by the deficits already run up this year throughout the NHS. Nearly everyone outside the government agrees that the £22 billion efficiency savings which Simon Stevens imagined as balancing the books cannot be achieved so the deficit will still keep on growing.
Except that there are some private sector suppliers rubbing their hands, not in healthcare but in IT. Articles from Computer Weekly and digitalhealth.net unearthed by Our NHS state that the Department of Health, advised of course by the notorious McKinsey consultants (whose 2010 Labour commissioned report provided part of the motor for the Health and Social Care Bill), has asked the Treasury for £3.5 billion for IT investment (including electronic records) in order to save up to £8billion. I think we've heard this one before and the problems associated with the implementation of STHFT's new Lorenzo system (palmed off by the government to desperate Trusts despite its being generally regarded as unfit) hardly help the credibility of IT led solutions. But rest assured - the Department is spending money on developing a digital maturity index to be applied to CCGs and health economies by the Care Quality Commission!
So there is going to have to be a lot of pressure to try and ensure that any additional funding does actually do some good. There is an additional problem in that the budget for the following 2 to 3 years is pretty flat. Real terms investment will drop to just £500m in the third year, before rising again to £1.7bn in 2020-21. And beware of percentages - different estimates of the total Department of Health budget are being used; also details of the overall budget under tomorrow's full spending review announcement are still not clear.
And where is the money coming from? Well, partly from the non ring-fenced parts of healthcare, including nurse training, public health and the Care Quality Commission, while the cuts in social care are being allowed only a smidgeon of necessary relief by allowing councils to raise an extra 2% in council tax - for which of course they will get the resentment. And then of course from all the other services (and service users, benefit recipients, tax credit claimants etc). Announcing the NHS budget separately from all the others shows that the Treasury still has not made the connections.
It's not exactly a recipe for national health - and incidentally the government yesterday closed a short and less than token consultation on its mandate to NHS England which was not publicised and barely noticed until Keep Our NHS Public people kicked up a stink because the website would not even accept responses to the consultation! In it they claimed that improving the nation's health was one of their overarching objectives. So why cut public health expenditure? And why put out an 8 page mandate which mentions staff only once?