Build back better? This budget was about business as usual…

On Wednesday 3rd March, Rishi Sunak, the Chancellor of the Exchequer, gave his second budget. From a health and social care perspective, Sunak’s two budgets as chancellor could not have been more different. 

In his 2020 budget, the NHS received guarantees in the strongest possible terms: “Whatever resources the NHS needs to deal with coronavirus, it will get,” he said. There was an emergency relief fund covering social care. It wasn’t perfect, but it was something.

In 2021, there was nothing of the sort. The NHS was hardly mentioned. The words “social care” weren’t mentioned even once. There was no extra money to support recovery or renewal. The end of the budget came with a shocking realisation: health, social care, and public health had been almost entirely left out of a budget delivered during a pandemic.

For a government committed to “build back better,” a budget should be an opportunity to outline and financially back a bold vision for a better future. At a minimum, it should have funded surge capacity in the NHS: more beds, investment in community, better technology, and workforce recruitment and retention. It should have funded free personal social care, or at the very least invested enough to see the sector safely through this year. It should have prioritised action on public health and inequalities at a minimum through the restoration of the public health grant.

This omission implies is that the chancellor is happy to settle for a return to business as usual instead. And that would be a disaster.

In the NHS, it would mean a return to a system run at the top of its capacity, rather than the top of its game. Analysis by the Institute for Public Policy Research (IPPR) recently looked at the state of the health system at the end 2019, on the eve of the covid-19 pandemic. We painted a stark picture of too few beds, hospitals with unsafe occupancy, huge vacancies in our workforce, large maintenance backlogs, poor access to innovative medicines, and antiquated technology. 

This was the “waste” cut during the austerity decade. The consequence was an NHS poorly configured to cope with bad cases of winter flu, let alone a global pandemic. Ahead of a likely spike in covid-19 infections this winter, and the health security threats posed by anti-microbial resistance and climate change, a return to this stretched system should not be our ambition.

In social care, it would mean a return to a system that has not worked for decades. Before the pandemic, quality of care was often low; unequal access and variation often high. There was endemic low pay for workers and many people faced ruin from catastrophic care costs. The huge impact of the pandemic on care home residents, workers, and providers will make things worse in the years to come.

Faced with incredulity that the budget had nothing for social care or social care workers during a post-budget morning interview, Rishi Sunak argued that he needed cross-party consensus. But an IPPR and Policy Exchange collaboration has already shown political and public consensus exists for free personal social care, delivered on the same basis as the NHS. There is no time to waste.

In public health a return to business as usual would mean living with more than a decade of severe government cuts. Research shows that, between 2014 and 2020, over £800 million was cut from the local public health grant. These are services designed to prevent the underlying conditions that were such a risk factor during the pandemic. 

Unsurprisingly, areas with the highest covid-19 death totals experienced public health grant cuts 3.5 times as high as areas with the lowest covid-19 death tolls. It is indicative of the last decade’s short sightedness, and of the folly of returning to the same regime. 

In a week’s time, IPPR will release a blueprint for building back better after covid-19. The landmark report will contain definitive analysis on what covid-19 has done to the health of our nation, and what an evidence-based government strategy should look like in response. 

At future fiscal events, including the spending review later this year, the government must prove they are up to the challenge.

Chris Thomas is a senior research fellow at the Institute for Public Policy Research.

Competing interests: None declared.