4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
Update 8th March 2021
The Chancellor announced a series of spending measure related to vaccines in the 2021 budget. These include:
• An additional £1.65 billion to support the Covid-19 vaccination roll-out in England
• £28 million to support for clinical trials and increase the UK’s capacity for vaccine testing and ability to rapidly acquire samples of new COVID-19 variants
• £22 million for a study to test the effectiveness of combinations of different Covid-19 vaccines and the effectiveness of a third dose of vaccine against current and future variants.
• An extra £5 million on top of a previous £9 million investment in clinical-scale mRNA manufacturing, to create a ‘library’ of vaccines that will work against Covid-19 variants for possible rapid response deployment.
The government has also recommended a 1% pay rise for NHS workers on the Agenda for pay scheme, an offer that has been widely criticised (see more section 2.2: workforce).
Update 17th January 2021
Five contracts have been signed by the government to secure up to 267 million vaccine doses at an expected cost of £2.9bn. This includes 100 million doses of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines that have already been approved and deployed in the UK. Non-binding agreements with two other companies for vaccines not yet approved in the UK have also been made, which may bring total vaccine provision to 357m doses.
Update 16th December 2020
The National Audit Office has released a report on preparations for potential COVID-19 vaccines. The report estimates that the cost of a COVID-19 vaccination programme in England could amount to ‘£11.7 billion which includes the costs of purchasing and manufacturing vaccines for the UK, deploying them in England and investing in global efforts to purchase vaccines’. These costs include £6.2bn for the Department for Business, Energy and Industrial Strategy to procure and manufacture vaccines and £4.9bn for the Department of Health and Social Care for the rollout of the vaccination programme. These estimates also include £619m that has already been committed by the government for global vaccine research, including approximately £548m to help low and middle-income countries to access vaccines.
The full report can be viewed here: https://www.nao.org.uk/press-release/investigation-into-preparations-for-potential-covid-19-vaccines/
Update 1st September 2020
As elective work was stopped in March, funding arrangements were amended from an activity based payment scheme to a block contract from April to July. The CQUIN system of incentive based quality improvement was also ceased until July (https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/COVID-19_NHS-contracting-and-payment_26-March.pdf). From April 3rd, NHS trusts could claim up to £250,000 in capital expenditures to support the COVID-19 response, including provision of COVID-19 testing (https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/05/C0518-changes-to-finance-reporting-and-approval-processes.pdf). To further support the recovery and restoration of elective services, a modified national contract was also put in place to enable use of independent hospital capacity until March 2021. The current arrangements are being adjusted to take account of expected usage, and by October/ November it will then be replaced with a re-procured national framework agreement within which local contracting will resume, with funding allocations for systems adjusted accordingly. To ensure good value for money for taxpayers, systems must produce week-by-week independent sector usage plans from August and will then be held directly to account for delivering against them (https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/07/Phase-3-letter-July-31-2020.pdf).
Update 1st June 2020
No new financial mechanisms have yet been proposed directly to support health system funding as part of the transition period, However, an additional £1.6 billion has been proposed to support local authorities, who will be critical in supporting the local resilience forums, which are a critical part of the response to social care and to supporting local communities.
An emergency response fund, initially set at £5 billion, has been announced to help the NHS, social care and wider public services to respond to COVID-19. However, more details on how these funds can be accessed, how they will be disbursed and how they will be distributed geographically and for which specific services and equipment is needed. There is also no information about where those additional funds come from, what they are intended to be spent on, or what expenditure might be reduced to compensate for the additional funding. Overtime pay has been promised.
On 19th March, the government announced a £2.9 billion fund to help support those deemed to be the most vulnerable in society. £1.3 billion of that was intended to support the rapid discharge from hospital programme and to fund temporary packages of care to facilitate that process. £1.6 billion went to local authorities to help their response to pressures arising from covid-19 – part of that was intended to support adult social care but it would be up to individual councils to allocate the funding across the many services they deliver. Some providers of social care have raised concerns that there is no system for ensuring the extra money will reach them and that cost pressures in the sector (e.g. from increases in the national living wage and rising PPE costs) are not being adequately recognized (https://careprovideralliance.org.uk/local-government-funding-for-adult-social-care-services). In response to this, the Care Minister has asked all Local Authorities to outline and publish how they intend to distribute their funding to support to care homes going forwards.
On 23rd March 2020, the Department of Health and Social Care announced that through the end of 2020, NHS England, rather than Clinical Commissioning Groups (local area bodies responsible for planning and commissioning of health services), will be in charge of commissioning services from the independent sector (https://www.gov.uk/government/news/nhs-to-benefit-from-13-4-billion-debt-write-off).
The government also agreed to pay statutory sick pay from day one of sickness for staff in care homes who were isolated (£94.25 per week for up to 28 weeks).
On 2nd April the government also wrote off £13.4 billion of historic debt for NHS trusts (https://www.gov.uk/government/news/nhs-to-benefit-from-13-4-billion-debt-write-off).
In light of growing numbers of deaths in care homes, on 12th May the government announced an additional £600 million to support infection control in care homes (https://www.themj.co.uk/Johnson-announces-600m-for-infection-control-in-care-homes/217593#).