Philip Hammond preparing his Autumn Statement. Photo: WPA Pool / Getty
NHS and social care funding crisis completely missing from 2016 Autumn Statement
“Departments will continue to deliver overall spending plans set at the Spending Review 2015”
That was how the Chancellor used the Autumn Statement to respond to the crisis in our NHS and social care services. The NHS, deep in funding crisis, wasn’t mentioned once – prompting a wave of anger and dismay from all corners.
Earlier this month we surveyed NHS workers around the country – 70% of them told us a lack of staffing and resources is putting patient safety at risk.
And they are not alone. We recently published a report with the NHS Support Federation showing that this year has seen an unprecedented wave of organisations from think tanks, health unions, NHS providers, MPs on the Health Select Committee, the National Audit Office and even the government’s own mental health taskforce all saying the same thing – lack of proper funding for health and social care means lack of staffing, lack of beds and threats to patient safety.
This week the National Audit Office produced its report on the financial sustainability of the NHS and found that:
With more than two-thirds of trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups unable to keep their spending within budget, we repeat our view that financial problems are endemic and this is not sustainable. It is fair to say aggressive efficiency targets have helped to swell the ranks of trusts in deficit over the last few years … There are indications that financial stress is having an impact on access to services and quality of care.
The Chancellor was oblivious to it all. Choosing instead to hide behind the same old rhetoric, wheeling out the myth of a £10bn funding increase that has been discredited by Tory MPs on the Health Select Committee, the Chair of the Public Accounts Committee, the King’s Fund , Nuffield Trust and Health Foundation and the UK Statistics Authority .
Appearing at PMQs before the Autumn Statement, Teresa May used the opportunity to extol the government’s track record on social care, showing that post-truth politics is well and truly here to stay.
Let’s just remind ourselves of the situation we are in.
The NHS is halfway through the most austere decade in its history. The real terms £4.2bn increase in health funding in this parliament represents an annual real terms increase of just 1.1 per cent – much the same as the last parliament.
Over the next four years, funding is set to drop dramatically, with near zero increases in 2018/19 and 2019/20 – just as demand for services will be peaking.
Meanwhile, capital funding, upon which so much of the NHS transformation plans depend, is being held at £4.8bn per year in cash terms, representing a real terms annual cut of 1.7 per cent.
NHS spending as a proportion of GDP is set to fall from 7.6 per cent in 2009/10 to just 6.9 per cent by the end of this parliament. A long way behind France, Germany, the Netherlands and Sweden, for example.
Two thirds of NHS trusts ended last year in deficit to the tune of £2.45bn and the prospect isn’t looking very much better this year – at the same time they are faced with the perfect storm of finding £22bn in efficiency savings while delivering new models of care across 7 days, with a growing crisis in recruitment, retention and morale across the service.
If anything, social care has it worse. Six years of budget cuts mean public spending on social care has fallen by over 9 per cent since 2010 and is set to fall below 1 per cent of GDP by the end of this parliament.
The government’s move to enable councils to fund social care by adding a 2 per cent precept to council tax is falling far short of what’s required. Even if every council used the precept every year for the next four years there would still be a £2.3bn funding gap.
The crisis in health and social care feed off each other. Just last week, I shared a pint and a gloomy chat with the Chief Executive of a London acute trust who fretted over a bed occupancy rate in his hospital of over 90 per cent, while the local residential care home had two floors unoccupied due to cuts to care commissioning budgets at the local authority.
All of this is having a detrimental impact on the services that patients receive, despite the best efforts of dedicated health and social care staff, with massive pressures throughout the system from mental health and GP practices to ambulance call outs, cancer treatment and elective care. Since 2010 there has been a 26 per cent reduction in older people accessing domestic and residential care.
This is turning into a national disgrace. No wonder that the Chancellor’s deaf ear to these concerns has been met with such outrage.
Here’s Mike Adamson, the Chief Executive of the Red Cross:
This is a humanitarian crisis that is only set to get worse. The British Red Cross has seen first-hand the devastating effects; people falling and not being found for days, people not being washed because there is no carer there to help them. We call on the Government to rethink their decision and allocate immediate funding to stabilise our care and support system, as well as create a sustainable funding settlement for the future.
Stephen Dalton from the NHS Confederation:
The treasury has missed a golden opportunity to ease the strain on the NHS. While the Government is right to review long-term spending plans, social care services are in crisis right now. Our staff delivering services on the frontline this winter will find it extraordinary that the government has turned a blind eye to the stresses and strains being felt in the health and social care system. Relying on a political rhetoric that promises to protect the NHS, but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.
And Richard Murray, Director of Policy at the Kings Fund:
The absence of new money for health or social care means that the already intense pressures on services will continue to grow. The lack of extra money for social care funding, in particular, means we are likely to see an already threadbare safety net stretched even more thinly. This will impact on some of the most vulnerable people in society, and so goes against the government’s commitment to creating a country that works for everyone. The government will also need to look again at health funding in future. The planned increases in health spending are not enough to maintain standards of care, meet rising demand and transform services. In particular, the pressures will peak in 2018-19 and 2019-20, when there is almost no planned growth in real-terms NHS funding.
Ominously, Julie Wood, Chief Executive of NHS Commissioners hinted at what this might mean in terms of cuts to services:
Commissioners, like providers, will still continue to wrestle with the increasing financial pressures across the whole health and care system, spiralling demand and a drive to achieve long-term sustainability and transformation, this is now more the case than ever. Our members will work as hard as they can to ensure that the best possible care is delivered to their populations, and the lack of investment in either social care or the NHS in today’s Autumn Statement means that it is now critical that we have an open and honest conversation about what the NHS can reasonably be expected to achieve for patients with the resources available to it.
The Local Government Association made clear their anger at the Chancellor’s lack of action on social care:
Councils, the NHS, charities and care providers have been clear about the desperate need for the Chancellor to tackle the funding crisis in social care. It is unacceptable that this has not been addressed in the Autumn Statement. The Government must take urgent action to properly fund social care if councils are to stand any chance of protecting the services which care for the elderly and vulnerable. Extra council tax funding will not bring in enough money to alleviate the pressure. Services supporting our elderly and vulnerable are at breaking point now.
Colin Angel of the UK Homecare Association was shocked:
But I’ll leave it to Diali Pas Gupta, Assistant Chief Executive of Birmingham City Council perhaps who captured the mood best, when she tweeted: