What's in store for the NHS's 70th birthday?

Winter and funding pressures dominate the calendar, but there are green shoots of transformation that could change how patients use the NHS next year

The first babies born on the NHS in 1948. Seventy years on, the service remains close to people's hearts but its challenges are increasing (PA)

The NHS launched into existence three years after the Second World War and on a wave of essential rebuilding and newfound socialist sentiment.

Its 70th anniversary will be marked in July and, with a certain wedding and the football World Cup also falling in 2018, the country should brace itself for a year of misty-eyed nostalgia and appeals to a unifying national identity.

But for the 1.3 million NHS employees this summer celebration is overshadowed by some much bigger events looming next year.

“Winter is top of your mind, for everyone who works in or around the health service. That goes without saying,” says Saffron Cordery, director of policy and strategy at NHS Providers, the organisation that represents NHS hospitals and ambulance trusts.

The release of the first weeks of NHS winter performance statistics showed that, one week in, the NHS is already under immense pressure.

Nineteen out of every 20 hospital beds in England are full, despite 85 per cent occupancy being deemed the safe operational limit. One in five hospitals in England, including the Royal Berkshire in Theresa May’s constituency, had at least one day without a single spare bed. All before a major cold snap or flu outbreak has hit.

But despite this seemingly inauspicious start, Cordery says that the NHS is about as prepared as it has ever been.

“We always thought this winter would be worse than last winter, for the figures to not be dramatically worse is an achievement,” she said. “We can’t say how it will look in three week, but trusts have put in more preparation than ever before and there are national plans as well.”

This includes the presence of GPs at the “front door” of A&Es, allowing patients who turn up to be seen and sent to the most appropriate place without taking up emergency care capacity.

There is also a wider push for NHS and social care organisations in local areas to work together to ensure the right skills are in the right place, so funding can be spent in the best way for the local area, rather than on shoring up each hospital.

Hospitals are working with care homes to get doctors visiting and checking on patients to prevent them getting so ill they need to come to hospital.

“It’s not as sexy as proton-beam therapy to save a child with a brain tumour,” according to Cordery. “But it’s going to improve quality of life and ease pressure on resources for thousands of people up and down the country”.

While this effort has been under way for years, “it’s bearing fruit now and being rolled out nationwide”, she added.

There are other projects that that could change the way patients use the health service in 2018.

By March half the country will be able to book a routine GP appointment in the evenings and on weekends, and this will ramp up to 100 per cent coverage for early 2019.

The Government is also consulting on a four-week waiting-time target for young people to access mental health support.

But the success of these changes hands on the funds and spare capacity available.

Grand ambitions have already taken a dent, after Chancellor Philip Hammond pledged just £1.6bn in the budget to keep services running next year – less than half the amount the NHS requested.

“There’s no massive 70th birthday transformational funding boost to pay for new technology and reverse waiting list decline. We’re more looking at muddling through,” says Siva Andaciva, chief analyst at the health think tank the King’s Fund.

The funding in the budget was given with the express purpose of restoring the NHS to hitting waiting times targets in A&Es and for surgical treatment that have been unmet for years.

While all experts agree the limited funds are unlikely to see these restored, Andaciva said talk of NHS failing to meet them do a “disservice” to an NHS that is managing to simultaneously run under massive pressure while slowly transforming into a more fit-for-purpose service.

“Every time I see someone from another country, they are staggered that we still see nine out of 10 people within four hours in A&E. Stepping back, the NHS has made such big strides, and with all this keeping your head down and muddling through, at a local level there is some pretty transformational work happening.”

He points to a scheme at Norfolk and Norwich University Hospital, which will open the NHS’s first A&E unit just for frail elderly people, as well as the plans in Greater Manchester where health responsibility has been devolved.

The NHS received £3.5bn in capital funding for equipment and buildings, and much of this will be earmarked for essential repairs and upgrades of run-down hospitals and surgeries.

But what’s left is will be invested in things like local health “hubs”, to house weekend GP services, and allow clinics for diabetes or joint problems, which would usually take place in hospital, to run alongside GPs.

But the biggest change for the NHS next year was left open-ended in the budget.

After seven years of pay for nurses, midwives and paramedics being frozen or capped at a 1 per cent, the Treasury announced that it would provide funding for a pay lift above inflation this year.

The scheme has devastated morale and staffing, with the numbers of registered nurses falling this year for the first time since 2013.

Official figures show there are 42,000 NHS jobs in nursing, midwifery or the allied health professions, such as physiotherapists, currently vacant.

Analysis by the Nuffield Trust, another policy think tank, found that compared with inflation NHS staff earned £2.6bn less each year because of this policy.

Hard-pressed staff instead opt to sell their services back to the NHS at higher rates, and at their convenience, by taking on private locum work.

The Budget made clear that it would rubber-stamp any recommended pay increase, but these will be contingent on “productivity improvements” and contract negotiations for staff on NHS Agenda for Change contracts.

These strings attached to any pay settlement are “concerning”, according to the Royal College of Nursing’s chief executive and general secretary, Janet Davies, who said nurses should not be expected to “fund their own pay rise”.

“More and more nursing staff are struggling to pay their bills or even to put food on the table for their families, and increased pay is vital so that existing staff stay, and the health service is able to begin to fill the tens of thousands of nursing vacancies,” she added.

The reforms of agenda for change staff contracts are likely to involve changes to unsociable working hours allowances, and this has raised concerns of a repeat of the junior doctors strikes in 2016.

“We do need more flexibility in the pay terms and conditions we’ve got across the NHS,” according to Saffron Cordery.

But the negotiations “need to be incredibly carefully handled” as if they breakdown the NHS will have “have lost a chance to boost morale and make sure people can get back on an even keel”.

If the Chancellor’s pledged pay gift turns out to be underwhelming, then 2018 could be an unhappy birthday for the NHS.