The bill sets out the minimum revenue funding that the NHS will receive every year until 2024 for the day-to-day running of NHS services, although it does not cover training for doctors, nurses and allied health professionals or the capital budget. And it does nothing to support vital services funded by local government.
Local government plans and secures crucial public health services like smoking cessation and sexual health which help keep people well and stop them needing more expensive NHS interventions. But the grant funding for these services from this April has not been confirmed by the Department of Health and Social Care.
Local authorities cannot plan for services when they do not know what their budget will be, and the consequence is that many providers of these services, including those in the voluntary sector, are having to put their staff on notice of redundancy as funding and contracts cannot be confirmed.
Given how important voluntary sector services can be for the most vulnerable in our population, this lack of certainty has real impact on people and communities. At a time when the NHS is facing unprecedented levels of demand, not supporting services that can help keep people well and away from the NHS is a false economy. Prevention is one of health and social care secretary Matt Hancock’s four priorities, yet prevention services are just two months away from an unknown financial position.
Adult social care services are also confronted with financial uncertainty. Since the local government financial settlement was confirmed soon after Boris Johnson entered Downing Street, the government has announced a 6.4% increase to the national minimum wage.
That is welcome news for the high numbers of people in the sector who are paid the minimum wage but poses a real challenge to local authorities who will have to pay for these higher costs when their budget increase is a long way from 6%.
There has been no word from ministers about how local authorities are expected to square that circle. Even if the government provided additional funds to cover the minimum wage increase, it would only help to keep the current social care system going. We are yet to see action from the prime minister to meet his promise to fix social care ‘once and for all’.
Aside from the funding, the NHS is yet to see the NHS People Plan – the workforce plan that will support delivery of the ambitions in the NHS Long Term Plan. Now expected after the Budget on 11 March, it will be more than 14 months between publishing the Long Term Plan and publishing the workforce plan. With 100,000 vacancies, there is no time to delay.
The government’s commitment to funding day-to-day NHS costs is welcome, but it needs to extend to providing stability and certainty to the whole of the health and care system.
It will be critical that the NHS takes care to not solve its own workforce crisis by exacerbating staff shortages in social care. Improved NHS pay and conditions would be welcomed by many, but could attract staff away from social care services which face equally grave staff shortages.