It was all eyes on the chancellor last week when he stood up to make his budget announcement. Perhaps more so than ever before. And no wonder. There had been a frenzy of speculation beforehand about the likely winners and losers, and whether some services – such as the NHS (who had been seen to do well in previous settlements) would come out with anything at all. This was accompanied by a wave of warnings about the consequences of not allocating the £4 billion that the independent health think tanks suggested was the amount needed for next year to maintain current levels of patient care.
And all this was set against a backdrop whereby the Office for Budget Responsibility had downgraded the economic outlook for the country which gave the chancellor even less to work with.
More than expected, less than needed
However, we know the outcome now. There is new money for the NHS to the tune of around £1.6 billion for next year alone, plus more help with capital investment over the next five years, and a one-off payment this year of £350 million to support the Service through the winter months. On top of this, and perhaps most welcome, is the commitment to fund the lift to the one per cent pay cap currently in place for nurses’ and other healthcare workers’ pay.
Thankfully all this is more than we and many working across the healthcare system expected.
Thankfully all this is more than we and many working across the healthcare system expected. However, in the final analysis it is less than needed.Director of policy and strategy
However in the final analysis it is less than needed. Perhaps it is this dilemma that has made public discussion of the budget settlement so fraught.
What we are talking about here is a number of gaps: gaps in funding, which translate into very real challenges in terms of services on the frontline of the NHS; and gaps in focus which appear to look rather narrowly at hospital and emergency services, rather than widening out the support to a wider set of services such as mental health, community and ambulances. These play a vital role and are experiencing very real pressures, which at the end of the day mean patients and service users waiting longer to access care, and risking their condition worsening because of this. And a final gap is any mention of additional money for social care. The relationship between health and social services is symbiotic – pressure on one is pressure on the other. This is an oversight.
A final gap is any mention of additional money for social care. The relationship between health and social services is symbiotic – pressure on one is pressure on the other. This is an oversight.Director of policy and strategy
We have listened to the views of NHS trusts and as early as March we pointed out this seemingly unbridgeable gap between the task that providers are expected to deliver and the available funding to deliver it. Even now, trusts will not be able to fully meet rising demand and need, and substantially recover performance targets within the current allocation.
And, sadly, the money to help the NHS get through winter has come too late. We wanted £350 million. It is what the service asked for – but to make the most of every pound we needed to see this given to the NHS back in July, so that additional beds, services and staff could have been put in place.
We have to get practical now. There are tough choices ahead in terms of what the NHS can deliver.Director of Policy and Strategy and Deputy Chief Executivetweet this
However, we have to get practical now. There are tough choices ahead in terms of what the NHS can deliver. But there is still an NHS to run and what trust leaders want to know is how and when that welcome additional investment will be allocated. The discussions to agree the NHS mandate – essentially what will and won’t be a priority for next year – need to be open and transparent and involve everyone accountable for delivering high quality services.
This article was first published by the Times on 28 November 2017
Read our ten reflections on the Autumn Budget