IIt was predictable that Wes Streeting’s department would emerge from this week’s budget as the winner, given the scale of the problems facing the NHS, particularly the huge waiting lists, and the strong public opinion on the matter. The promised increase of £22.6 billion over two years, plus £3.1 billion for repairs and equipment, will bring the average annual increase in daily spending in England to 4%.
As large as these numbers are, they are far from transformative. The historical average increase is 3.6%. An aging population, new medicines and medical technology mean that Britain and other Western democracies will need to increase healthcare spending by around this amount to meet voters’ expectations.
Rachel Reeves’ description of her spending plans as a “down payment” was appropriate in relation to health. Ministers hope this will improve morale among patients and the overburdened workforce, and provide a platform on which longer-term plans can be built.
The challenge ahead of them is enormous. Public health in Britain has not recovered since the pandemic, as in comparable countries, and 900,000 people have disappeared from the workforce. Experts increasingly link the country’s economic performance to its poor health status. The left-wing Institute for Public Policy Research (IPPR) has labeled Britain the “literal” sick man of Europe. A recent report calls for a once-in-a-century review and a reorientation toward prevention and away from treatment.
This is in line with Labour’s promises manifestoand the findings of Lord Darzi’s review. The burden of chronic and mental health conditions means a stronger focus on public health is needed. Problems like obesity, which ultimately send people to the hospital, need to be addressed earlier.
But this will not be easy at a time when budgets are under pressure. Public health programs, such as investments in physical activity and education, cost money upfront, even if they lead to savings later. How a system-wide shift towards prevention will be achieved is a key question for the NHS’s 10-year plan, promised next spring. How we can shift the balance of NHS funding from acute hospital trusts to local primary care is another matter.
Efficiency savings and technology will be part of the government’s plans. But apps and digital documents, while useful, will not provide a silver bullet for deep-seated structural and human problems. What is worrying is the IPPR’s view that the NHS is “not organized in a way that allows change”; Lord Darzi believes the role of integrated care councils – which now have regional oversight of the NHS – needs to be clarified. And while no one disputes the knock-on effect on the NHS of the underfunded social care system, an early solution seems highly unlikely. Increases in national insurance may mean that, despite a £600 million funding increaseThis budget increases rather than decreases pressure on the healthcare sector.
After fourteen years of underinvestment and a pandemic, turning around the fortunes of the NHS was always going to be a Herculean task. The continued pressure on the system poses risks, not least the boom in private healthcare, which could eventually erode public support for the NHS. But there is also reason for hope, now that these first pieces are in place. Ministers know they will be judged on the NHS, which despite its shortcomings remains one of their party’s great achievements – and one of Britain’s most valued institutions.
-
Do you have an opinion on the issues raised in this article? To submit an email response of up to 300 words to be considered for publication in our letters section, click here.