It was predictable that Wes Streeting’s department would emerge as the winner from this week’s budget, given the scale of the difficulties facing the NHS, particularly its vast waiting lists, and the strength of public feeling about this. The promised increase of £22.6bn over two years, plus £3.1bn for repairs and equipment, will bring the average annual increase in day-to-day spending in England up to 4%.
Big as these numbers are, they are far from transformative. The historical average increase is 3.6%. Ageing populations, new drugs and medical technology mean that the UK and other western democracies need to raise health spending by around this amount to meet voters’ expectations.
Rachel Reeves’s description of her spending plans as a “down payment” was apt in relation to health. Ministers hope it will lift morale among patients and an overstretched workforce, and provide a platform on which longer-term plans can be built.
The challenge before them is enormous. Population health in the UK has not bounced back since the pandemic, as it has in comparable countries, and 900,000 people have been lost from the workforce. Increasingly, experts link the country’s economic performance to its poor state of health. The left-leaning Institute for Public Policy Research (IPPR) has labelled the UK the “literal” sick man of Europe. In a recent report it called for a once-in-a-century overhaul, and reorientation towards prevention and away from treatment.
This is in line with the pledges in Labour’s manifesto, and the findings of Lord Darzi’s review. The burden of chronic and mental illness means a stronger focus on public health is needed. Problems including obesity that eventually lead people to hospital should be tackled earlier on.
But this will not be easy at a time when budgets are under strain. Public health programmes, such as investments in exercise and education, cost money upfront even if they lead to savings later on. How a system-wide shift towards prevention will be engineered is a key question for the NHS 10-year plan for England, promised next spring. How to tilt the balance of NHS funding away from acute hospital trusts, and towards primary care delivered locally, is another.
Efficiency savings and technology will form part of the government’s plans. But apps and digital records, while useful, will not supply a miracle cure for deeply embedded structural and human problems. Worryingly, the IPPR’s view is that the NHS “is not organised in a way that makes change possible”; Lord Darzi believes the role of the integrated care boards – which now oversee the NHS in England – needs to be clarified. And while nobody disputes the knock-on effect on the NHS of the underfunded social care system, an early solution looks highly unlikely. National insurance rises may mean that, despite a £600m funding increase, pressure on the care sector rises rather than falls following this budget.
After 14 years of underinvestment and a pandemic, turning around the NHS’s fortunes was always going to be a mammoth task. Continuing pressure on the system brings risks, not least the boom in private healthcare which could, over time, erode public support for the NHS. But there is also reason for hope, as these first pieces are put in place. Ministers know that they will be judged on the NHS, which remains despite its flaws among their party’s great achievements – and the UK’s most valued institutions.
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