While the recently published Darzi report laid the blame for the current failings of the NHS squarely with Conservative governments, the problems are now owned by Labour after their July election victory, and there is a pressing need for patients to see real improvements in services. Broad aims to utilise technology, shift care into the community and focus on prevention need clarification in terms of detailed plans for how things will be made better in practice. Campaigners have long been calling for a £20bn funding injection as a down payment on what is needed to start the process of repair. This demand was coupled with calls for a commitment to a publicly funded and provided NHS and fair pay settlements for staff. Darzi’s stark diagnosis of a critically ill service starved of funds also sets the scene for the government to prescribe necessary treatment, the details of which are expected to be set out in next spring’s 10 year plan.
The recent budget enables Labour to argue that it has started on the path of restoring NHS services, with one aim being a return to meeting NHS performance standards in the next five years. The NHS was a key issue in the election, and Labour is likely to be judged next time around on how much it has been able to deliver in terms of real progress. A major concern remains that unspecified ‘reform’ is being prioritised over greater investment, despite the fact that New Labour showed, the last time that Labour ‘saved the NHS’, that a sustained increase in funding was crucial to reducing waiting lists and improving public satisfaction. In addition, the Secretary of State for Health and Social Care, Wes Streeting, insists in the face of all evidence to the contrary that the private sector is there to help out and must play a key role in recovery.
What did the Budget promise?
The headlines for the NHS were an additional £22.6bn over the next two years for day-to-day spending, and a further £3.1bn capital over the same period. The government also announced that £1bn of the capital investment would be used to tackle the backlog of repairs and upgrades with a further £1.5bn for new beds in hospitals across the UK, around one million additional diagnostic tests, and new surgical hubs and diagnostic centres. This is aimed at reducing waiting lists (currently standing at nearly 8 million) and increasing numbers of hospital appointments and procedures in England by 40,000 per week (at present there are nearly two million weekly hospital appointments).
The £22.6bn will inevitably be eroded by pay settlements, by staff recruitment as the workforce plan is implemented and by inflation. Alarmingly, with an estimated current £4.8bn underfunded shortfall in NHS England revenue budget there will be no more money immediately available, despite the need to tackle a crisis that is seeing 14,000 avoidable deaths each year simply from delays in Emergency Departments. The £1bn of the capital funding for urgent repairs includes the seven hospitals in danger of collapse due to being constructed with Reinforced Autoclaved Aerated Concrete. These need rebuilding at an estimated average cost of £1bn each (as part of the much bigger but as yet unfunded New Hospitals Programme). £600m has been allocated for upgrades to 200 GP surgeries, and £70m for radiotherapy machines. Social care is to receive a paltry £600m, and like general practice, the sector will be hit by the rise in employer National Insurance contributions despite public services being protected from this. For GPs, also being hit by a 6.7% rise in minimum wage for practice staff, this seems inconsistent with Labour’s pledge to ‘bring back the family doctor’ (20% of practices closed between 2013 and 2023) and reduce pressure on hospitals.
How much extra funding does the NHS need?
Some figures give a sense of just how much money the NHS might need if our People’s Vision of a restored service based on its founding principles is to be achieved. In the decade preceding the pandemic, annual spending increases were significantly below the long-term historical average for nine subsequent years. As a consequences, the British Medical Association estimates that since 2009/10 there has been a £44.6bn cumulative underspend compared with historical funding settlements. The Health Foundation considers that to enable the NHS in England to meet growing demand and improve standards an additional £38bn funding each year until 2029/30 would be necessary. Lord Darzi identified a £37bn capital investment deficit compared with similar countries, and the NHS Confederation has been calling for an annual £6.4bn capital funding increase to ensure staff have the right tools and space to work effectively. There is currently a maintenance backlog of £13.8bn needed to bring NHS estates to an adequate condition.
A small step in the right direction
While welcoming the announcement of extra funding, it is crucial that this be invested in the NHS as a public service provider and not diverted to short term profit taking companies. Investment in social care and in rebuilding public health services should also be prioritised, and there must be a real cross departmental focus on reducing health inequalities by addressing the social determinants of health and the promotion of social justice. With climate change now the biggest threat to public health, it is lamentable that this hardly featured in the budget except for a welcome increase in air passenger duty for private jets.
The budget was a missed opportunity for wealth redistribution from rich to poor. A much needed tax on the very wealthy was avoided and a manifesto pledge to tax the huge profits made by private equity bosses was considerably watered down. This is despite government stating that money for investment in public services should come from those with the broadest shoulders. This is urgent given compelling evidence of how a failing NHS will lead to a failing economy. As Darzi said in a clear message to government, ‘It is not a question of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around’.
So often complex accounting practices and shifting definitions of what constitutes NHS spending obscure the true financial state of the NHS and its funding needs, as well as how much of the money promised will translate into reality. While welcoming the budget as a small step in the right direction, the likely reality is that it will only help maintain services but not mean patients will see an improvement in care. If Darzi saw the NHS as a critically ill patient, then the journalist Frances Ryan is spot on to categorise the budget as ‘£22bn worth of cardio-pulmonary resuscitation’. It raises questions as to just how committed Labour is to restoration of a publicly provided NHS. Much more will be needed to return it to healthy status, including a far greater commitment in the coming 10 year plan.
