overspend by some £2.5 billion next year; it also begs the question of how much of the cash might be needed to plug an overall deficit this year. Paul Baumann, NHS England’s chief financial officer, told the Commons Health Select Committee in November, that achieving overall financial balance this year is ‘absolutely on the knife edge.’ So the headline figure may not prove to be quite what it seems, and it is likely to take a few weeks—if not a few months—to work out where the announcement really leaves the service. One should not, however, be over curmudgeonly. The money is also, the chancellor said, ‘a down payment on the NHS’s on long term plan’—in other words, on October’s Five Year Forward View. A down payment does at least imply that there will be more to come at some point, and it is a measure of the success of the Five Year Forward View that politicians of all parties have, at least on the face of it, adopted it as their own; or as a credible way forward for the service in times of continued austerity. Simon Stevens, Chief Executive of NHS England, unsurprisingly, welcomed the cash, saying it would ‘kick start transformation’—and the really big question is how far it will provide at least some room for manoeuvre to do that. The Five Year Forward View posited half-a-dozen or so models for getting hospitals, primary and community care to work together in a more integrated fashion. It is a model for providing a better service, and hopefully a more cost-effective one, for those patients who form the biggest current challenge to health services—people with multiple conditions, and most notably the frail elderly, who end up too often and too unnecessarily in hospital. The Five Year Forward View did not, in so many words, adopt the idea of a ‘transformation fund’ to get these up and running. But it did contain an implicit recognition that some may involve double running costs to build a new service before an old one closes down. Stevens raised that idea in his health select committee evidence, saying that NHS England will be looking at ‘the case for freeing up some of the cash from day to day operations in order to lever in some of these new models.’ Quite how they are to be brought into existence, with what degree of central support, was the big unanswered question in the Five Year Forward View. Quite how the extra cash will help with that is the big unanswered question that lies behind the announcement of additional money. BJHCM Nick Timmins, senior fellow at the Institute for Government and the King’s Fund examines George Osborne’s announcement of £2 billion extra funding for the NHS A £2 billion boost for the NHS
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Feb 11, 2015
Alison Moore 
Open Access