£13bn Budget boost won't cover NHS backlog and will only 'paper over the cracks' of social care, critics warn

Chancellor's annual Budget speech sparks reaction from health and social care sectors

While spend is increasing, Sunak could not confirm the cash would completely address the backlog
While spend is increasing, Sunak could not confirm the cash would completely address the backlog

In his recent Budget speech, Chancellor, Rishi Sunak, committed to raising around £13bn a year for health and social care spending across the UK.

However, his failure to provide a guarantee that this would address the considerable backlog that has built up as a result of the COVID-19 pandemic, and a lack of long-term vision for social care services, has led to widespread criticism.

In this Budget and Spending Review speech, Sunak said money raised from the proposed new Health and Social Care Levy would go directly to the NHS and social care sector – describing it as the ‘largest health capital budget since 2010’.

Measures announced include:

  • £2.3bn over the next three years to transform diagnostic services, with at least 100 community diagnostic centres across England
  • £2.1bn over the next three years to support innovative use of digital technology so hospitals and other care organisations are as connected and efficient as possible
  • £1.5bn over the next three years for new surgical hubs, increased bed capacity, and equipment to help elective services recover, including surgeries and other medical procedures

But Sunak admitted this may not be enough to restore services.

While we should never turn our nose up at more funding towards our health service, the money will have little impact if it isn’t used correctly

He said: “I don’t think anyone can make a guarantee on the backlog, that it’s going to be cleared, or will fall by a certain amount.

“If you want to know why we can’t guarantee it, it’s because it also depends on demand.

“We estimate there are seven million people who stayed away during the height of the pandemic... and we don’t know how many will come back.”

Record investment

And he said these efforts were not helped by significant staff shortages across the NHS.

Commenting on the announcement, Dr Layla McCay, director of policy at the NHS Confederation, said: “Health leaders will welcome the record investment given to the NHS and they appreciate its significance in the context of a pandemic that has been so damaging to our economy.

“However, the Treasury will know that the NHS’s allocation in the Spending Review falls short of what is needed to get services completely back on track.”

And Siva Anandaciva, a health analyst at The King’s Fund health think tank, said the success of the plans would need to be underpinned by action to address inequalities.

We estimate there are seven million people who stayed away during the height of the pandemic... and we don’t know how many will come back

“The new NHS funding comes with specific targets to increase activity to reduce the backlog.

“This is a sensible approach, but there is a significant inequalities issue here, as our analysis shows that those living in the most-deprived areas are nearly twice as likely to wait more than one year for treatment compared to those living in the least-deprived areas.

“To help reduce inequalities, the Government should work with the NHS to implement the activity target in a way that allows appropriate local flexibility to address health inequalities.”

A particular area of contention was around the apparent lack of a long-term vision for the beleaguered social care sector, which has largely been ignored in previous budget announcements.

Enough is not enough

In his speech, Sunak confirmed that councils with care responsibilities will continue to have the option of charging an adult social care precept of up to 1% per year on top of council tax, without holding a referendum.

And the Government is relying heavily on the previously-announced Health and Social Care Levy to provide £5.4bn ‘to reform adult social care’.

Of the total, £3.6bn will be allocated to the cap on personal care costs and associated means test, in addition to ‘moving towards a fairer cost of care’ in local markets.

The £4.8bn funding to local government, and the recently-announced Health and Social Care Levy, will help paper over the cracks for some councils for a while longer, but it will not transform social care

And another £1.7bn is intended to ‘improve the wider social care system’ including integration, and £500m to invest in care workforce skills, qualifications, and wellbeing.

In addition, the Spending Review commits to maintaining the Public Health Grant in real terms.

But speaking to hdm, Nick Clarke, head of social care consulting at Grant Thornton UK LLP, described the investment as ‘papering over the cracks’, adding: “The biggest financial pressures most councils are currently facing are in relation to social care and this is already having a direct – and significant - impact on the NHS as some people cannot be discharged safely from hospital into residential or home care as there’s no capacity to provide the care needed.

“Which is, and will continue to, directly impact the NHS’s ability to reduce the backlog in surgeries, even with the additional funding announced in the Budget

“The £4.8bn funding to local government, and the recently-announced Health and Social Care Levy, will help paper over the cracks for some councils for a while longer, but it will not transform social care.

“And, until the collective budgetary need of both the NHS and social care, together, is considered to meet the short and longer-term challenges they face – with a fully-integrated approach to tackle those challenges, especially around prevention – nothing will.

“Ultimately, when their specific allocations are made, councils will still face tough decisions on how much to allocate to social care departments.

“With an ageing population, more complexity of need, staff and carers leaving the sector for better-paid jobs, significant increases in safeguarding enquiries, inflation-busting increases in care costs, the National Living Wage increase, more people with mental health needs, spiralling SEND spend, and more children needing social care support and intervention, the list is nearly endless and the decisions unenviable – and the money will go very quickly."

Unprecedented demand

Care England chief executive, Professor Martin Green, added: “Winter is going to be very tough without a robust social care sector to support the NHS.

“Failure to support adult social care will result in unprecedented demand.”

And chairman of the Local Government Association, Councillor James Jamieson, said: “It is disappointing that the chancellor has not provided additional funding to address existing pressures on adult social care services and not increased public health funding.

“We remain concerned that the money allocated to social care from the Health and Care Levy will be insufficient to fund reforms.

“The potential rise in local government core spending power over the next three years will also be dependent on councils increasing council tax by 3% per annum.”

We remain concerned that the money allocated to social care from the Health and Care Levy will be insufficient to fund reforms

Social care providers are also concerned. Speaking to hdm, Nick Sanderson, chief executive of care developer, Audley Group, said new approaches to the delivery of care for older people, such as later-living and retirement villages, needed to be considered.

He adds: “While help towards easing up the waiting times is warranted, we need to be looking at how we can stop hospital visits in the first place, particularly for our ageing population.

Holistic solutions

“There won’t always be more and more money to sink into the NHS.

“If the Government firstly started to consider social care and housing in the round, we could actually create holistic solutions for our older people and prevent the issues building up.

“Living in accommodation that facilitates independent living along with bespoke, flexible care is associated with a lower uptake of inpatient hospital beds.

“And, if a hospital visit is needed, the freedom to then return to your own property with the necessary care on hand is surely the better choice.

“This, in turn, will ease up pressure on the NHS as it frees up hospital beds.

“While we should never turn our nose up at more funding towards our health service, the money will have little impact if it isn’t used correctly.”

 

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