The NHS has its spending settlement for the next financial year – this was confirmed at the Spending Review last November. There may be some additional emergency slugs of Covid-19 cash provided, as we now have more certainty about the trajectory (and therefore cost) of the vaccination programme, for example. Local government may hope for additional support, given the impact on demand for its services, and on income, and the perilous state of many local council finances. As a bare minimum, local authorities will hope that the Budget will end the wait for overdue allocation of the public health grant – the lack of certainty of funding impedes local public health teams’ ability to plan and it’s frankly hard to excuse the ongoing delay. Social care – as part of local government – has its settlement too, though it may reasonably expect some of the short-term injections of pandemic support to be repeated into next year. But the Budget will not be the time for resolving some of the long term strategic questions about the financial framework for health and care – be that social care reform, multi-year funding for workforce training and development, or the approach to tackling the backlog of unmet needs across health and care. These will be reserved for the Spending Review, expected later this year.
This Budget is much more likely to be a Budget about the economy and jobs rather than one where the focus is on public services budgets and delivery. But that doesn’t mean that the Budget isn’t relevant for health and care – it couldn’t be more so. Social determinants are a far larger factor in someone’s health than the quality and amount of health care they receive. An individual’s employment status, wellbeing, living conditions and income all have a greater impact on their health than the accessibility and quality of care provided by health services. The decisions the Chancellor makes on the furlough scheme, or on the temporary increase to Universal Credit, for example, will have an impact on the health of the population – and the impact will be felt for years by health and care services.
But the health and care system doesn’t need to just be a passive recipient of the poor health that result from those social and economic factors. It can play an active role in shaping those factors and look to leverage its full range of hard and soft powers to improve population health.
The recent Department of Health and Social Care White Paper confirmed that integrated care systems (ICSs) will be created in legislation as the organising principle for integration within the NHS and between the NHS and its wider partners. Critically, the stated purpose of ICSs’ includes improving population health and health care, and helping the NHS to support broader social and economic development. This gives a platform for the NHS to see its role differently – not just as a provider of health care services, but as a direct and indirect influence on the wider determinants of health. Tackling poverty is an example of where the NHS can play a more active role working with its partners. We will be publishing further work shortly on how the NHS can increase its leadership and role in reducing poverty and mitigating its impact, through awareness, action and advocacy.
As the biggest employer in England and a significant economic force in local communities, the NHS has a unique opportunity to use its resources to influence the wellbeing of the population it serves and reduce the health inequalities that exist in England. The NHS has a clear role as a significant economic player in the local community and many are now embracing this role through the concept of anchor institutions. This can allow the NHS to view its role and impact in the round – beyond provision of services to its impact as a local employer, its connection to the local economy through the goods and services it buys, and its ability to invest in skills and opportunities for local people. Social care has a similar opportunity to be seen as a player in the local economy – with Skills for Care estimating there are 1.65 million jobs in the sector. While these roles may be employed by many more, and in many cases much smaller, organisations than in the NHS, the potential impact of these employers in the local economy should not be forgotten.
So, 3 March may not be a Budget day where we are trawling through the detailed spending tables in the annexes of HM Treasury publications to see the medium-term future of spending for the NHS, public health and social care. But it will be a Budget day that will have a profound effect on future health and care needs. The health and care system can use its role and reach, and its new partnership structures, to think radically differently about how it shapes and mitigates the wider social and economic determinants of health.