John Kell
Head of Policy

Today's announcement by the Prime Minister of a new funding settlement for the NHS is a short measure. Let's be clear about why.

A superabundance of evidence and analysis has flowed into the Government (see for instance this from the IFS / Health Foundation / NHS Confederation), and it has all pointed the same way: to put the health service on a sustainable footing, annual real-terms increases of 4% or a bit more are essential, ideally with some of that front-loaded to sort out the current problems.

Note that's 4% of the whole health budget, including public health, workforce training and capital expenditure.

Instead, what the Prime Minister has announced is 3.4% of only a portion of the budget – the bit that funds front-line NHS services.

What does that mean? At best, it means the recent slide in the NHS's ability to deliver effective care for patients will be halted for a while, but it's not likely to recover significantly.

Maybe for the next few winters there will be a bit less in the way of unsafe and undignified treatment on hospital corridors. But will we be able to make the leap to an NHS that keeps people well in their own homes, rather than leaving them inadequately supported with multiple long-term conditions, until they reach a crisis and have to be admitted to hospital? That will now be much harder to achieve than it should be.

As for integration of health and social care, we're still in a 'two leaky buckets' situation, albeit that the NHS one has been caulked a fair bit. We will have to see what the summer brings in terms of the social care green paper, and there is much briefing in the air today that there will be some sort of funding solution in the Budget this autumn.

Meanwhile, the NHS will have to continue its scrabble to save cash, to make the new funding go as far as possible while sorting out the current problems such as the large provider sector deficit, and patients will continue to bear the brunt of it. We've already seen restrictions placed on the medicines available on the NHS, with further proposals to restrict 'low value' treatments on the way – experience to date shows this is incredibly hard to do without accidentally shutting some people off from the treatments they need.

The other behaviours that are the hallmark of a cash-strapped system will very likely persist, albeit they might not get much worse for now. Clinical commissioning groups will continue to have an incentive to restrict NHS Continuing Healthcare packages, forcing some seriously ill people with a choice between getting the care they need and staying in their home. Spurious bars on elective surgery will carry on, and even then the waiting lists will remain above where they should be, leaving patients in pain and discomfort too often.

We had hoped to be discussing where to spend the extra money this morning (boosting community services as part of a bold service transformation programme, in full partnership with patients, would have been the answer, for what it's worth); instead, this announcement will be enough to do a fair job of papering over the cracks for a while.

Amid the disappointment however, it's right to give some credit to the Health Secretary, and also to Simon Stevens. Reports emerging this morning strongly suggest they put everything on the line in some very tough negotiations with the Chancellor and the Prime Minister, to the point where talk of the resignations of either or both was in the air at various times if the deal was grossly inadequate. The robust nature of these negotiations is also reportedly why Mr Hunt refused to be moved from his post in the January reshuffle, fearing a new-in-post successor would be unable (or even unwilling?) to close the deal. In the event they seem to have succeeded in moving the Treasury much further than it initially wanted to go – still not far enough, but the responsibility for that almost certainly has to be placed with the Treasury.

There also remains a lot of uncertainty. What we have had today is a couple of newspaper articles, most notably the Prime Minister's in the Mail on Sunday, and a lot of media briefing creating media reports of varying levels of credibility. Where is the detail? What exactly has been agreed? How will the increase in funding been distributed across the five year period? How exactly has it been calculated? (The announcement seems to take 2018-19 as a baseline, so have the planned increases to 2020, modest though they were, been counted as part of this figure – ie, is some of it not in fact 'new' money?) How will it be paid for? What exactly will happen to the budgets outside the ring-fence? We don't seem likely to have answers to all of those questions any time soon.

That said, anyone playing bingo for political red herrings will have shouted 'house!' almost immediately. The PM's article takes a crowd-pleasing shot at NHS 'bureaucracy' (for context, the NHS's productivity gains have comfortably outstripped the economy's as a whole in recent years, and by any global comparison it's as efficient as any health system out there and comfortably better than most). Reliance is already being placed on as-yet undeveloped new technology to solve at least some problems. Greater demands will apparently be made of the NHS in return for the cash, even though it's just about enough to steady the ship but no more. And the new money is being spun both as coming from extra tax and as being a 'Brexit dividend' - those things are certainly not both true.

Meanwhile, the 'NHS Assembly' will produce a ten-year plan, 'led by doctors' according to media briefings. What about patients, Prime Minister?

If the Government is disappointed not to get credit here, it only has itself to blame for a half-baked announcement. This could and should all have been sorted out at either of last year's Budgets, or countless opportunities before; instead, we have a disappointing headline figure and a lack of detail underneath it that together add up to more anxiety for patients about the long term future of the NHS, not reassurance. Perhaps the Chancellor has moved further than he wanted, and some credit is due for getting things as far as they have got. But we're here to speak up for patients – it's not our role to pretend to be pleased when the wrapping paper comes off the present and it turns out to be a massive let-down.

Theresa May photo by EU27EE Estonian Presidency on Flickr, under Creative Commons Licence CC BY 2.0.