On the face of it, the figures sound huge. Rachel Reeves’ first budget included an additional £22.6bn for day-to-day health service spending, plus £3.1bn extra towards capital investment. There is some sleight of hand at play: those sums are spread across two years and represent a real-terms annual increase of 3.8 per cent. This is the level at which health service inflation has historically run, so the budget has for now put the NHS back on its long-term trend. But it does nothing to address the funding shortfall accrued over the austerity decade, when budgetary growth was pegged at an average of 1.4 per cent, a slow-motion but key cause of the “broken” NHS we see today. Reaction from leaders across the sector could be summarised as a cautious welcome: the cash injection will help stabilise things, but much more will be needed if the NHS is to be repaired.
This tepid reception fails to take account of what the Health Secretary, Wes Streeting, has repeatedly stated: alongside receiving extra resources, the NHS must be reformed. The historic 3.8 per cent annual NHS inflation will have to match the long-term UK growth rate of around 2 per cent, otherwise spending on health will continue to account for an ever greater proportion of public spending. The details of Streeting’s reforms will start to emerge in 2025. For now, all we have are the three broad brushstrokes: analogue to digital, hospital to community, and sickness to prevention.
Some commentators have decried the Budget’s cash injection as simply pouring yet more money into a failed system. But that misunderstands the problem. Rather than “broken”, the NHS might better be described as seized up. We are beset by “failure demand”. Patients whose problems aren’t diagnosed and dealt with in a timely manner don’t just sit by, meekly waiting till the system finally gets round to them. They continue to present to their GP surgeries, to A&E departments, to the ambulance service – worried, in pain, increasingly disabled, their lives on hold. For many, their condition deteriorates with the delay, rendering it more complex, urgent and expensive when they do get treatment. For some, the hiatus proves fatal. The £22.6bn cash injection, and the 40,000 additional hospital appointments we are told it will fund each week, is the budgetary equivalent of WD-40. The aim is to get the NHS’s constituent parts moving once again. There is a pressing political imperative for that, of course. But it will also be a prerequisite for reform.
The major flaw with the Budget is that it will unintentionally exacerbate the failure demand currently paralysing the system. It perpetuates the UK’s political blind spot: that the NHS is what goes on in hospitals. Virtually all the additional resources are destined for secondary care, and there is nothing to shore up general practice, district nursing, health visiting, pharmacies – all of which have been decimated over the past ten years. Health needs that are not met in primary care don’t go away; they inevitably turn up in secondary care, amplifying system costs and compounding the logjams in the hospital sector. It is astounding that Streeting has let this pass: he is on record as recognising that the UK is an international outlier in the amount of activity that takes place in secondary care.
This failure to inject parallel resources into primary care will be acutely compounded by the gross political miscalculation over the steep hike in employers’ National Insurance contributions, from which much of the additional spending will be derived. Hospital trusts are exempted, but currently there is no such protection for the organisations that provide most NHS services in the community. Unaddressed, the new NI regime will cause further contraction and closure of the very parts of the system that Streeting will eventually look to in order to deliver on his reforms. He won’t be able to move care out of hospitals, let alone enhance prevention, if he continues to preside over the destruction of general practice, and its allied services in primary and community care.
[See also: To the young, everything is fresh and new]
Content from our partners
Related
This article appears in the 07 Nov 2024 issue of the New Statesman, Trump takes America