As good as it gets

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By Professor Judith Smith
School of Social Policy, University of Birmingham

In these straitened economic times, public services awaited the Chancellor’s Autumn Statement with trepidation, wondering where and how deeply the axe of funding cuts was going to fall. Trailers for the Statement had intimated tax increases, major spending constraint and delays to much-needed policy and infrastructure developments

These portents turned out to be largely correct, but some sectors have fared better (or less worse) than expected and none more so than the National Health Service which is to receive an additional £3.3billion in each of the next two years ‘to enable it to achieve key priorities’.    

There are indeed many key priorities for the NHS as it faces its toughest winter on record, grappling with rising demand for urgent and emergency care, missed targets for cancer treatment, astonishingly long waiting lists for elective operations, unprecedented pressures on general practice, major concerns about the quality and safety of care in sectors such as mental health, learning disability and maternity, and (as if all that were not enough) 130,000 unfilled staff vacancies. Images of ambulances queuing for hours outside accident and emergency departments are just one indication of this multitude of pressures.

As Chancellor of the Exchequer, Jeremy Hunt has deep knowledge of the NHS, having been the longest serving Secretary of State for Health and Social Care and until very recently Chair of the House of Commons Health and Social Care Select Committee.  In similar vein, the current Secretary of State for Health and Social Care, Steve Barclay has experience as Chief Secretary to the Treasury. This hinterland, together with wise negotiation and advice from Amanda Pritchard the Chief Executive of NHS England, may have afforded the NHS a degree of protection from the winds of extreme austerity.        

A particularly welcome announcement was that the Government will publish an independent workforce plan for the NHS for the next 5, 10 and 15 years, something that has been long called for as a vital prerequisite to investing in training, deploying and retaining the staff required to meet future health needs.  This needs to be mobilised as a matter of urgency, with cross-party political commitment to fund and act on its projections and will be eagerly awaited by all quarters of the NHS. 

A surprise in the Statement was that Patricia Hewitt, a previous Labour Secretary of State for Health and now Chair of Norfolk and Waveney Integrated Care System is to lead a review of how newly formed Integrated Care Systems can work in an appropriately autonomous and efficient manner.  This echoes one of the Chancellor’s other announcements of more regional devolution deals, apparently seeking to share the challenge (for which read pain) of managing public sector austerity with local mayors and authorities.  The findings of the review will be important in shaping better integrated health and social care, something that is much needed to help solve the NHS and other pressures but is fiendishly difficult to achieve.

The additional funding for the NHS, whilst welcome, is much less than needed – a bandage for a gaping wound.  Service pressures are upon us, industrial action looms, workforce plans take years to bear fruit and NHS and social care staff are utterly exhausted after almost three years of pandemic.  Social care has gained some additional funding from the Autumn Statement, but the major reform of this sector’s funding and provision has once again been kicked further into the long grass.

The comment that struck me most forcibly when listening to the Chancellor give his statement was ‘we want Scandinavian quality alongside Singaporean efficiency’.  This is likely code for shape up and deliver.  The NHS must expect heightened political and public scrutiny of its progress against targets including A&E waiting times, access to GP appointments, waiting lists and cancer treatment times.

For the population, there is scant hope of a swift return to an NHS that meets its targets and for staff there is but tentative progress towards addressing profound shortages and pressures.  For the NHS, the Autumn Statement was as good as it gets in times of major economic turmoil.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham.

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