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How Boris can make the extra cash for the NHS really count

10 August 2019

9:00 AM

10 August 2019

9:00 AM

It would be daft for someone to offer you £1.8 billion and you turn it down. That sort of money isn’t to be sniffed at. This is how much Boris Johnson announced he would give to the NHS as an extra funding boost. And I don’t want to seem churlish or ungrateful — after all, those of us who work in the health service are always banging on about how NHS resources are near breaking point. But I have some reservations.

The first is the most basic — I’m not sure this is quite the cash windfall it’s made out to be. While Boris has assured us that ‘this is £1.8 billion of new money [that] wasn’t there ten days ago’, Sally Gainsbury, senior policy analyst at the Nuffield Trust thinktank, said that the money was actually from hospitals that had accumulated it by making savings in capital expenditure introduced by Theresa May. She said it was ‘the equivalent of giving someone cash then banning them from spending it, only to expect cheers of jubilation when you later decide they can spend it after all’.

But still, wherever it’s come from, it’s better to have it to spend than not. The bigger issue is that despite promises of more money, those on the coalface so rarely get to see it. I never turn up to work after an announcement like this to find an extra nurse or doctor. Dieticians or occupational therapists don’t materialise after a politician tells us we’ll receive more money for the NHS. It’s an ongoing joke at work about where the money actually goes.


I work in mental health, and talking to colleagues from a range of mental health services it seems that despite promises from politicians, we haven’t had an increase in staff or resources. Waiting lists have been brought down slightly over the past few years, but that’s simply a result of a variety of sleight-of-hand techniques, such as shifting responsibilities back to GPs (who are struggling as a result), increasing thresholds for patients receiving care, or reducing the amount of treatment patients actually get.

Too often extra cash just gets poured into debts or goes to offset rising costs. The legacy of the Blair years was PFI — private finance initiative — which saw hospitals get into hugely costly contracts with private providers. These still cripple many of them today. We need to centralise all the PFI debt because until we do this, extra money getting to frontline services is always going to be dependent on whether the hospital is in debt or not. This is the absolute crux of it. Yes, by all means give the NHS more money, but please make it come with a rider: that it has to be invested in frontline services. It has to be spent on something that actually helps patients.

It would be much better also if it was given to something very specific and clear, otherwise there’s too much of a temptation for hospitals to use it on things with no clear impact — managing debts, wasteful vanity projects or yet more managers. Why not make it incredibly specific?

Cataract operations, for example. Cataracts are associated with increasing social isolation and decreasing independence. Sorting them out actually saves money elsewhere, because poor vision is linked to a raised risk of falls, fractures, road traffic accidents, depression, anxiety and dementia, to name but a few. The operation is quick and easy. Yet NHS clinical commissioning groups, in an attempt to make savings, are increasingly denying them to patients. That £1.8 billion could fix around two million eyes. It would pay for everyone currently waiting for a cataract operation for the next six years. That’s quite a legacy. It’s not going to solve all the problems, but it would mean a real, demonstrable increase in quality of life for a lot of people who are currently being given quite a raw deal by the NHS.

If this doesn’t float Mr Johnson’s boat, then increased spending on prevention and primary care also makes sense. Give the money directly to GPs, insisting they use it to increase out-of-hours appointments.

Or give it to mental health. Considering the economic and social burden of psychiatric disease, let alone the human suffering of it, this would make sense. But insist it is only used to fund more nurses. Then we’d really see the impact on the ground and, most importantly, so would patients.

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