By Professor Judith Smith, Director of Health Services Management Centre
School of Social Policy, University of Birmingham
For the NHS, there were in effect two Budgets: one for the short-to-medium-term to address the Coronavirus crisis, and the other to continue with the previously announced five-year investment in the NHS to enable it to meet its Long Term Plan commitments.
For the short- to medium-term, a £5billion contingency fund was announced to support public services to deal with the Coronavirus outbreak, and it appears that much of this will flow to the NHS – to deliver more Covid-19 testing, equip and staff hospitals, increase intensive care capacity, enable virtual outpatient and general practice services, and support the expected surge in demand for emergency care.
Exactly how this contingency money will be allocated is as yet unclear, and NHS leaders will need firm commitments from the Treasury, the Department of Health and Social Care, and NHS England to enable them to press on with confidence in making urgent staffing, procurement and other expenditure.
Similarly, it will be vital that some of this contingency fund can be deployed to strengthen and support social care, including residential and nursing homes, and home care agencies, for these services, will face huge pressures to help keep frail and vulnerable people well-supported. Social care services have faced deep cuts in recent years that have left the sector struggling to cope, and they will need funding and capacity to scale up at this time of crisis.
For the medium to longer-term, the prior commitments to increase NHS funding – a promise made by Theresa May on the occasion of the NHS’ 70th birthday – remain in place. There are some welcome extensions to these planned uplifts in the Budget, including an additional £1billion in the coming year for capital investment to address building maintenance and refurbishment issues, and a further £1billion of revenue funding to help progress the Government’s ambition to train, recruit and retain more nurses, GPs and other health professionals.
The announcement of changes to pension rules to try and resolve the problem of high earners (such as NHS consultants or GPs) finding that they cannot take on extra duties without suffering financial losses will also be welcome news to NHS employers.
Despite these additions to funding for the coming year, the most profound challenge facing the NHS continues to be its lack of workforce and the high number of staff vacancies it is carrying, and much more policy and funding attention needs to be given to this issue, and the long-awaited NHS People Plan has much hope riding on it.
The most depressing, although unsurprising, aspect of the Budget was the familiar lack of serious attention to major long-term investment in social care, apart from confirming cross-party talks to try and build consensus on reform. We have however had serial reviews and commissions on the future of social care funding and provision, as many experts have noted.
We urgently need reform of social care funding whereby the costs are shared much more equitably across our population, and new models of care developed that can properly meet the requirements of an ageing population living with ever more complex needs.