Thread by @ADMBriggs

Given the #NHS70 'birthday present', thought I'd share my reflections on recent changes to funding for health, public health, & social care in England. This is based on a talk I just gave to @DartmouthInst in US.
Credit @TheIFS, @HealthFdn, @TheKingsFund & others for images. 1/

Both in the US and England, the balance of money and political power lies firmly with the (acute) provider sector at the expense of community orgs, public health, social services, and (perhaps to a slightly lesser extent) mental health and primary care. 2/

Yet, very little of what determines both individual and population health is due to the provider sector, instead, social determinants and unhealthy behaviours are much more important. #SDOH 3/

Current integrated care reforms (vanguards, STPs, ICPs, ICSs etc) are just the latest in a long line of attempts to get different parts of the health care system working more closely together. But this time it's in the context of historically low/stagnating funding growth. 4/

Not only is rate of overall NHS spending growth over the past 10 years unprecedented, the £1.8bn funding for these transformation/integration efforts has basically be swallowed up by NHS trusts' deficits (which was twice as bad this year than shown in this figure). 5/

And despite this as well as significant NHS productivity improvements, the situation has got pretty dire at times. This is likely due to systemic under resourcing across health care, social care, and public health ifs.org.uk/publications/1…. 6/

Over the same period, funding for local government and particularly social care, (all those social determinant bits) hasn't been stagnating, it's been declining. 7/

The same goes for local authority public health funding. Initially it was protected before being raided. It has therefore seen cuts alongside gaining additional responsibilities. 8/

The integration acronym spaghetti of vanguards, STPs, ICSs, ACOs, and ICPs is important and well intended, but was poorly communicated, rushed, under funded, and needs better governance and outcomes (see @CommonsHealth report and previous thread

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) 9/

For me, public health seems missing from much of the narrative. STPs and ICSs are a unique opportunity not to be missed. How can prevention be better addressed and how can public health contribute? 10/

I am often reminded of this paper on public health 3.0: cdc.gov/pcd/issues/201…
Public health consultants can be the chief strategist for STPs, the honest broker between the different NHS and LA organisations. 11/

And then comes Theresa May's #NHS70 birthday present. A v welcome cash injection but only equates to 3.4% pa rise in NHS England finances and just 3% in Department of Health funding.
It will keep the lights on but is considerably less than the 4% thought to be required. 12/

The sleight of hand is that it is *just* NHS England funding. Leaving DH out means that training, public health & infrastructure are also left out.
And social care is no-where to be seen. See @TheIFS & @HealthFdn report for why this is so important: ifs.org.uk/publications/1… 13/

Therefore the detail of this year's budget is crucial. What isn't said will be as important as what is.
When we all know that investment in prevention, social determinants, public health, and training are so important, leaving them out seems so shortsighted. 14/

But through all of this, I'm optimistic about what STPs can offer if done right. The @CommonsHealth report recommendations are excellent but Brexit is distracting & we need to continue to keep long term investments health, prevention, & social care on the political agenda. 15/

And it could be much worse. 16/16

What many things have I missed/got wrong?

@sarahwollaston @davidjbuck @doctor_oxford @hughalderwick @profchrisham @AnitaCTHF @felly500 @jimmcmanusph @ADPHUK @AnitaCTHF @BenGershlick @DrDominiqueAllw @harryrutter
Thread on thoughts around NHS/PH funding which may be of interest.