Editorial Tuesday 24 November 2015: Simon Stevens' Newtonian politics win front-loading of the NHS budget (objects in motion)

"For every action, there is an equal and opposite reaction" - Third Law Of Motion, Sir Isaac Newton

"Every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it" - First Law Of Motion, Sir Isaac Newton

The Sun King Also Rises, you might say.

From what the press release tells us, NHS England chief executive Simon Stevens has played a tough hand with consumate skill, drawing to fill an inside flush.

Remind me not to play poker with Simon, when it comes to lese-majesté, won't you?

Crispin Dowler of Health Service Journalhas the full early figures here, along with good analysis of the missing links and consequences.

Of course, nothing is perfect. The baseline looks like it's last financial year's (2014-15), which has all sorts of yet-to-be-determined OBR deflationary consequences.

And no doubt there will be a cadre of 'give-us-£8 billion-this-year-goddamnit-with-cream-and-sugar-on-top!'-niks.

Inevitably. Well, good luck to them; may it keep them warm.

But rather more good luck, not to say congratulations, are due to Simon Stevens, who has obtained £3.8 billion front-loaded funding for the NHS this coming financial year, and £1.5 billion the following, which is a Very Great Deal more front-loading than a significant body of opinion in HM Treasury wanted the NHS to have.

Sympathy For The Treasury
This willl probably be the shortest ever few paragraphs on Health Policy Insight, but you can just about see a HM Treasury case. 'Local government has taken serious 25-40% financial pain: why shouldn't the NHS face similar?', the gnomes of Whitehall whimper.

'Because we don't measure the loss of quantity and quality of reduced social care provision', would probably be a fair answer.

Yes, a fair answer.

It's not a nice answer, of course.

But then, social care needs are not nice, are they? They're not smart society. Most of us and ours are lucky enough not to have disabilities which leave us reliant on the support of others - on the state, on taxpayers, on 'hardworking families' if you absolutely must.

But those reliant people are the ones who get shafted when what has been done to local authority funding gets done.

(Deep breath. Deep breath. It's OK: you can look yourself in the mirror. One more deep breath.)

So that's everything sorted with the NHS, yes?
Um, no. Sorry.

Financial front-loading seems set to come with the end of public bursaries for nurse training, and cuts to Public Health England budgets also look certain.

These trade-offs matter, and as the details emerge from the appendices and small print, there will be more to say. Particularly my oft-used line that robbing Peter to pay Paul focus-groups terribly well with the Paul demographic.

There are still huge changes to provision ahead of us. Consolidation, place-based re-shaping ... these are going to be as difficult as they always have been.

And one size will definitely not fit all. The time of the NHS redisorganisational onesie are long gone. (At some point, politicians may even notice this. Hey-ho.)

There are no Messiah Concepts.

If you've seen one thing work once somewhere, you've seen one thing work once somewhere.

Culture is a big beast wth a long shadow, and the NHS still needs a chief anthropologist far more than it needs any chief inspector (oh, I have mentioned that before, you say?)

Oh yes, and the network beats the hierarchy.

In other words, this money doesn't buy off the need for authentic, deep and difficult change. It doesn't fix everything.

But it also gives us something very important; something vital.

And that's not just hope.

Hope matters, hugely. But if we didn't have hope, we wouldn't still be hanging around this neck of the woods.

So actually, we can almost take hope as read.

Simon Stevens' political capital: shaken, not spent
No: this settlement gives us a system leader who put his political capital well and truly into the fire, yet didn't spend it - and certainly didn't come close to wasting it.

Someone who put his political life on the line, frankly. And came out alive.

Someone whose five tests were, in the event of a failure to front-load the funding, unambiguously going to be the real-world version of the NHS Mandate. Because that's how grown-ups negotiate. Using strategy, and thinking.

Someone who could have sat back in a well-paid, stimulating international job based in the USA, and watched. But someone who chose not to do that, and instead chose the hard option.

Someone who's not the Messiah - who certain people probably now think is "a very naughty boy". But someone whom only Chairman Mal can fire - and that's not looking likely.

No, Simon Stevens, political winner, is here for the longer term. And that is good news, writ large.