Could the Autumn Budget 2024 be more important for its vibes than its spending announcements?

There are lots of reasons to care about the Autumn Budget 2024. Even a ‘normal’ budget contains important details about the government’s spending plans over the coming year. And we have had a run of far-from-normal Budgets in recent years, containing everything from the introduction (and abolition) of new health and care levies, the end of the private finance initiative (PFI) programme and huge spending increases to help services during Covid-19.

But there is another less-heralded reason to care about the budget: vibes. These fiscal events are an important part of a government’s narrative over where the country and our health and care service are heading. In essence, these fiscal events are part of a wider story. So, as we approach 30 October, here are three ways in which the autumn budget might move the story on.

The first thing the budget might do is resolve some of the cliffhangers from previous fiscal events. Back in March 2024, the then-Chancellor, Jeremy Hunt, used his Spring Budget to announce the results of the ‘most ambitious public sector productivity review ever undertaken by a government.’ The NHS would be given an extra £3.4 billion of capital investment over three years (starting from 2025/26) to modernise antiquated IT systems and deliver up to £35 billion of productivity savings by 2029/30. Whether this funding will still be there, or earmarked for this purpose, will be something to watch out for on 30 October.

The second thing to look for are new plot details. There is growing speculation that the government will increase employer national insurance contributions. Cue references to the NHS being one of the largest employers in the world and hugely affected by this potential change: even if the government compensates public sector employers for increased costs (as it did three years ago when introducing the health and care levy), there may be indirect pressures on the spending power of public sector organisations if other bodies in the health and care system see their running costs increase.

The third thing to look for will be the leitmotifs of previous fiscal events. Look back at nearly ten years of fiscal events and there are at least four issues that recur.

• Public health – alcohol duties tend to be frozen, and the public health grant is maintained in real terms (at best) with the details of the grant announced very late before the start of the next financial year.

• Adult social care – the system is given short-term financial support to keep it just the right side of a tipping point; extra funding comes from a complex mix of government grants and flexibilities for councils to raise local taxes (even though councils with the greatest needs can often struggle to raise funding through this route).

• Capital investment in buildings and equipment – often maintained in real terms at best (though budgets have been growing more quickly in very recent years); if new funding is allocated, it is often earmarked for specific national priorities like the new hospitals programme.

• NHS day-to-day (resource) spending – spending is often topped up, even if budgets require further topping up still over the course of the next year as new staff pay deals and rising cost pressures emerge.

So, back to the narrative then. Before the election, the Labour Party committed to reforming social care and delivering long-term programmes with a significant impact on day-to-day spending (ie, the NHS long-term workforce plan) and capital investment (ie, the New Hospitals Programme).

But 100 days into the new government, the new hospitals programme and long-term workforce plan are now under review and adult social care reform has been paused. For a government that has committed to radical reform of the health and care system – and who drop the drop the word ‘reform’ into every other speech – it can sometimes feel like the government has its foot on both the accelerator and brake at the same time.

The Autumn Budget may only be the prelude to the wider Comprehensive Spending Review next year, which will set longer-term budgets for this parliament. But it is still an opportunity to send an early signal that this government is approaching things differently. An early indication that the public health grant could increase in real terms, allocating more capital investment outside of hospital, giving local systems more freedom over how capital spending is prioritised, greater use of central grants rather than local taxes to support social care… any of these actions would represent a turning of the page and a real demonstration of the government’s commitment to its stated reforms.

I remember speaking to someone senior in NHS finance circles who had heard the calls for ‘reform’ but cautioned ‘I can’t break free in one leap.’ They are right. But the government needs to at least take a few more concrete steps towards a health and care funding strategy that is more stable and focused on the long-term. It needs to start to write a new story. Because we have been living the old story for too many fiscal events. And if there’s one thing I’ve learned, it’s that the old story doesn’t end well.