Rishi Sunak’s budget said next to nothing about the NHS, and nothing about social care: and that’s a kick in the teeth for NHS England and all of the organisations that have pressed hard for spending increases to put the NHS back on its feet, tackle backlog maintenance and reward staff for their extraordinary efforts during the covid pandemic.
Behind the smiles and the silence was the Chancellor’s decision to slash back COVID-19 funding to NHS England from £18 billion this year to just £3bn for 2021-22.
NHS England core spending which had been planned to rise from £130bn to £136bn in 2021-22 will therefore be increased to just £139bn including covid funding. This is £9bn less than the £148m received in 2020-21, despite covid deaths still averaging 1,500 or so per week, the continued pressures on expanded ICU capacity and the fears of the global spread of the new Brazilian strain of the virus through Britain’s porous airports and inadequate privatised test and trace system.
The “extra” £3bn to help restore services after covid turns out to include £1.5bn of money previously announced, £1bn to cut waiting list backlogs and £500m for mental health.
This is a far cry from the request of NHS Providers CEO Chris Hopson, who had argued for the Chancellor to maintain spending at the higher 2020-21 level of £148m until 2023-24, when it is due to reach that level anyway. Hopson warned that as well as reducing waiting lists there are additional post-Covid costs to the NHS: “the reality is that in the long term we will need to see more money to help the health service meet increased demand across hospitals, mental health, community and ambulance services.”
OBR chair Richard Hughes has also warned that Sunaks’ allocation of funding takes no account of NHS costs tackling backlog waiting lists, vaccination programmes and test and trace.
This latest decision to impose austerity on the NHS follows the decade of disinvestment and decline since 2010. At the end of 2019 NHS Providers belatedly pointed out that if NHS and social care spending had risen each year in line with the average prior to David Cameron taking office, the Department of Health annual budget would already have been £35bn higher.
But another major concern is the absence in the budget of any increased capital investment into the England’s NHS to tackle the massive £9bn backlog for maintenance – which rose almost 40% in 2019-20, and is now almost as large as the entire DHSC capital budget.
Without additional capital there is no realistic prospect of remodelling many hospitals to adapt to the post-covid need for social distancing and improved infection control, reopening thousands of closed beds and restoring their capacity to treat routine and emergency patients as well as covid: nor will any of the new hospitals promised since Johnson took over as Prime Minister be affordable.
A significant increase in revenue is also needed to cover a major increase in NHS pay across the board for the staff who have gone above and beyond for an exhausting year to keep services going and save lives. Health union surveys have found large numbers of staff considering leaving the NHS as soon as the pandemic pressures ease – as a result of exhaustion and rock-bottom morale in a service that was on its knees before the pandemic struck, and now has up to 50,000 staff off sick with covid in addition to 84,000 unfilled vacancies.
To make matters even worse, Sunak’s failure to lift the cap on the Life Time Allowance for pensions is a calculated rebuff for thousands of senior doctors and consultants, despite warnings from the BMA after their survey of more than 8,000 doctors in the run-up to the budget found that 72% felt a freeze on the pensions lifetime allowance would make them more likely to retire early - and 61% said they would be more likely to reduce their working hours or shift to working less than full time.
John Lister is founding member and former co-chair of Keep Our NHS Public.