- In our view, the most urgent priority for the government’s one-year Spending Round should be adult social care. The social care system has now reached crisis point and is failing the service users, families and carers who rely on it, with high levels of unmet need and providers struggling to deliver the quality of care that older and disabled people have a right to expect.
- Over recent years, expenditure on adult social care has fallen: in 2017/18 spending was £700 million less in real terms than in 2010/11. However, in our 2018 joint report with the Health Foundation, we cited Personal Social Services Research Unit (PSSRU) projections that on current trends, social care spending pressures will rise at an average of 3.7 per cent a year until 2030/31. This is the minimum short-term increase in social care spending required. However, as well as additional short-term funding, social care requires significant reform and a new long-term funding settlement to deliver a fairer, simpler and more generous system.
- While the Spending Round does not consider capital spending, it remains the case that underinvestment in capital has left the NHS with deteriorating facilities and equipment. This has contributed to a maintenance backlog of £6 billion, including a £3 billion cost to improve estate that presents high or significant risks for patients and staff. Without a sustainable and long-term capital investment programme it will be difficult to achieve the scale of productivity improvements and service transformation set out in the NHS long-term plan. The recent announcement of a £1.8 billion increase in NHS capital spending power is therefore welcome, though not sufficient to address the scale of the issue.
- NHS trusts, primary and community care and social care are all experiencing chronic staff shortages. Along with the Nuffield Trust and the Health Foundation, we estimate that the gap between workforce supply and demand in acute and community health services could rise to between 250,000 and 350,000 full-time equivalent (FTE) employees by 2030, posing a significant risk to the delivery of the long-term plan. In our joint report, Closing the Gap, we found that the additional cost to Health Education England of workforce development measures and international recruitment to address the workforce gap stands at £620 million in 2020/21, rising to £870 million in 2023/24.
- There are also significant issues around recruitment and retention in the social care sector. Skills for Care forecast that by 2035 there will be 650,000 to 950,000 additional job roles across adult social care to meet growing demand, while turnover rates are in excess of 30 per cent per year. Addressing shortages in the NHS must not come at the expense of the social care workforce.
- Since the 2015 Spending Review, the public health grant for local authorities has been progressively cut and is now £850 million lower in real terms than in 2015/16. This reduction has seen local authorities cut spending on vital services like drug treatment, smoking cessation and sexual health services, which play a key role in improving population health at a local level. Spending reductions on preventative services have been greatest, while spending on clinical treatment has been cut to a lesser extent (Robertson 2018). Across all public health services, a minimum of £1 billion will be needed to restore funding in 2020/21 to the levels of 2015/16.
- There was an expectation that a full three-year Spending Review would take place in the autumn of 2019, which would provide a long-term settlement for the areas identified by the Committee. The decision to postpone this and the associated delays to budget setting, itself poses a risk to the successful implementation of the NHS long-term plan.