So far, the Prime Minister appears to be putting his money where his mouth when it comes to delivering on manifesto commitments – we’ve already seen new spending commitments to bring back maintenance grants to boost the pipeline of new nursing and allied health professional trainees, and additional money pumped into primary care through the new GP contract. At a minimum, we can expect the day-to-day funding for the NHS will need to be clarified at the Budget, covering the additional day-to-day spending enshrined in the NHS Funding Bill plus the additional commitments that have been made since the election.
Key commitments have included 50,000 more nurses and 6,000 more GPs, and with action taken to date we can see that the government looks to be taking them seriously. But the additional commitments made so far are not the only pieces necessary to complete the jigsaw. A comprehensive, long-term NHS People Plan is required for the system to be able to recruit, train and plan with certainty. To support this, Health Education England’s budget – the body that commissions training for doctors, nurses and allied health professionals – could be confirmed to 2023/24 (which would bring it in line with the budget for NHS England).
To make inroads into the staffing crisis in the NHS, The King’s Fund, Nuffield Trust and Health Foundation estimated in Closing the gap that Health Education England would need an additional £900 million per annum compared to 2018/19. Although additional investment has been promised, there is still a long way to go. Resolving the NHS pensions taxation issue will also be key to ensuring we have the necessary senior clinicians and managers to lead service delivery and improvement.
The commitments around NHS infrastructure were the next big manifesto commitment. As the Treasury has already suggested that the Budget is going to go big on infrastructure, more capital for the NHS seems likely. Alongside enough capital to support the ambitions for 40 hospitals, the NHS needs a stable and sufficient mainstream capital budget to allow for routine maintenance and improvement of its infrastructure – not just across hospitals but also primary care and community health services.
For adult social care, the Prime Minister of course promised to ‘fix it once and for all’. But so far, the problems for social care have got bigger – with inflation-busting increases to the National Living Wage and the prospect of a new migration system that will cut off a key supply of staff from overseas, both driving higher costs. Higher wages for low paid staff are obviously very welcome, but they must be properly funded and the current funding commitments are simply not enough. At a minimum, the Budget will need to set out an emergency injection of cash for April 2020 to help local government – the biggest purchaser of social care – to meet those higher costs and continue to meet people’s care needs. However, the long-term reform of social care will not be ticked off the do list at the Budget: history will have taught the government not to drop an unexpected social care policy out of the blue. But clarity about the process and timetable from now is needed – repeated promises are not enough and a clear process to get to resolution is required.
Turning to public health, a manifesto commitment to extending healthy life expectancy by five years by 2035 while narrowing inequalities in health sets the ambition but there is little detail on how. While population health is about much more than public health services, the first step is for directors of public health to have confirmation of their public health grant allocation from April, details of which have still not emerged weeks away from the start of the financial year. Decisions on long-term funding for public health funding seem likely to be held back until the Spending Review – where a ‘health in all policies’ approach could really help shift health outcomes.
Finally, it’ll be worth keeping an eye out for two other areas that will impact on health and care. What will the Chancellor say about local government finance reform – will the current plan for local retention of business rates be put on hold for fundamental review of the business rates system? And what might the approach to the ‘levelling up’ agenda mean for health and care?
The Budget is likely to provide answers to the some of the big questions for health and care but it will not provide the certainty across the sector as a whole – for that we can will need to wait for the Spending Review.