Good afternoon and welcome to my latest patient safety update. In a truly seismic week for health and care we look at the new levy and what it will really mean for social care, the backlog and patient safety as well as the latest on Covid. As ever, if you have been sent this email by a friend and want to sign up for yourself you can do so here.

BULLET WELL AND TRULY BITTEN No Conservative government likes to increase taxes so even Boris Johnson’s fiercest critics would have to concede it was a big move to increase taxes on income by £12 bn a year to fund health and care. The money was needed (and it is interesting that no one is really questioning that this morning) so instead there is a rather cooked-up debate on whether an income tax rise would have been more progressive than the new levy. I was concerned a pure National Insurance rise would be unfair on the young but in fairness the government listened to those concerns and the levy will be paid by working pensioners and on dividends too. Full details are available here but surely the big picture is that both the NHS and care system are in a much better place today than they were two days ago, as I told Channel 4 news and Newsnight (3 mins 13 seconds in) last night and wrote in a twitter thread. You can also see my slightly risqué question to the PM here.

WHAT NEXT? Much debate now about whether the package will actually deliver for the social care sector. Last September the Select Committee said social care needed a minimum of £7 bn extra per annum by the end of the parliament. This falls well short of that for the next three years (a £1.8 bn increase a year which many say is not enough) but could rise to that kind of level when the NHS backlog is dealt with as the total annual pot from the levy is £12 bn. Even though few people think the backlog will be dealt with by then or the NHS will willingly spend less money, much of the increase for social care after 3 years is ‘baked in’ with hard commitments on the new £86k cap and commitment that no one with assets of less than£100k will have to spend more than 20% of them to fund care in any year (with all costs paid for those with assets below £20k). So on the funding side, whilst there is understandable disappointment about the settlement for the next few years, there is all to play for after that. Overall I am reminded of Henry Kissinger’s definition of diplomacy as the ‘patient accumulation of partial victories.’

NHS BACKLOG The Health Foundation argue that £17bn is needed to clear the backlog over the course of this Parliament and so the sums offered by the levy may again fall short of that - but NHS England seems pretty happy it has to be said (which they were very much not even a couple of weeks ago). However the big question is whether the system can expand its capacity by enough even if funding is in place. Anita Charlesworth told the Select Committee yesterday that it will need 18,000 new nurses and 4,000 new consultants which cannot be plucked from trees - or even imported from abroad as we are not the only country with a Covid backlog. Overhauling workforce planning is therefore going to be the next big battle to win, something I asked the Chancellor about yesterday as the Treasury has been most sceptical of the excellent changes to the Health and Care Bill proposed by the health think tanks, which I strongly support.

BACKLOG VS SAFETY? How do we stop another Mid Staffs happening with the massive focus on bringing down waiting times? Patient safety campaigners are getting increasingly worried about this but Anita Charlesworth had an interesting suggestion yesterday that the NHS tariff should contain a safety/quality element. But in the end all roads on patient safety do lead back to getting staffing right as Dr Andrew Goddard told the committee.

NOT FORGETTING COVID…AND BOOSTERS It seems strange to deal with Covid quite so far down this update but it is not every day that a Conservative government raises taxes to fund the NHS and care system. First some stats: the latest ONS figures show a slight rise in cases from last week with 766,100 people in the community in England with Covid, still hovering around the 1 in 70 people mark. More worryingly the government’s Covid dashboard has cases increasing 13.9% for the most recent week, hospitalisations going up by 1.6% and deaths increasing by 39.2% compared to the previous week. More evidence in my view that we really need to crack on with a vaccine booster programme, something I asked the Vaccines Minister about on Monday. For more details on this see my article here but for balance here is the counter view from AZ’s Pascal Soiriot today.

NOSOCOMIAL INFECTIONS More evidence that infection control measures in hospitals need serious rethinking as we approach the winter as the HSJ has found that nearly one in five Covid deaths were probably hospital acquired. This is something many of us have been talking about for well over a year so I really hope Trusts give proper consideration to what more they can do to improve ventilation amongst other measures on their estates.

BILL COMMITTEE STARTS The Committee looking in detail at the Health and Care Bill started its work earlier this week with a couple of evidence sessions. You can keep up to date with their sessions here and watch back those they’ve already held via parliamentlive.tv. I’ll be taking a close interest when they get to the workforce clauses as I hope we’ll see something more from the government on this issue given its importance to pretty much every health and care issue at the moment.

Jeremy Hunt