{"id":49778,"date":"2021-03-10T14:39:12","date_gmt":"2021-03-10T13:39:12","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49778"},"modified":"2021-03-15T13:10:36","modified_gmt":"2021-03-15T12:10:36","slug":"recovery-from-covid-19-relies-on-nhs-staff-yet-last-weeks-budget-had-little-to-say-on-health-or-social-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/10\/recovery-from-covid-19-relies-on-nhs-staff-yet-last-weeks-budget-had-little-to-say-on-health-or-social-care\/","title":{"rendered":"Recovery from covid-19 relies on NHS staff, yet last week&#8217;s budget had little to say on health or social care"},"content":{"rendered":"<p><em><span style=\"font-weight: 400\">The Budget had too little to say about the future for healthcare and was entirely silent on social care, writes <strong>Nigel Edwards<\/strong>, CEO Nuffield Trust<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400\">Last week\u2019s Budget took place in the shadow of the greatest health crisis this country has faced for a hundred years, and was focused on setting the financial framework for a UK recovery from covid-19 that NHS staff will make possible. Yet after following events like this for many years, I can hardly remember a Chancellor standing up with so little to say about health or social care.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The headlines, and the opposition, focused on the <\/span><a href=\"https:\/\/www.theguardian.com\/society\/2021\/mar\/04\/labour-30bn-dhsc-budget-cut-will-hit-emergency-nhs-england-funding\"><span style=\"font-weight: 400\">striking headline<\/span><\/a><span style=\"font-weight: 400\"> number that funding for the Department of Health and Social Care is to fall by \u00a330 billion from next April compared to 2020\/21.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In one way that is unfair. The apparent drop is because covid-19 specific health funding is set to fall from an astonishing <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/966868\/BUDGET_2021_-_web.pdf\"><span style=\"font-weight: 400\">\u00a358 billion this year\u2014<\/span><\/a><span style=\"font-weight: 400\">much of it spent outside the NHS for initiatives like Test and Trace\u2014to \u00a322 billion next year. The latter figure is likely to rise as the Treasury puts more money in from reserves, and core funding for health will actually rise by \u00a37 billion.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But the dramatic falling away of covid funding illustrates the underlying problem here: the lack of long term planning and provision to tackle the huge issues that the NHS, social care, and people\u2019s health will face as the pandemic recedes.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Even before covid-19 the NHS faced <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/research\/the-health-care-workforce-in-england-make-or-break\"><span style=\"font-weight: 400\">serious staffing problems<\/span><\/a><span style=\"font-weight: 400\">, and a demand for care greater than it could meet meant that <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/qualitywatch\"><span style=\"font-weight: 400\">nearly all major waiting times targets<\/span><\/a><span style=\"font-weight: 400\"> were being missed.<\/span><\/p>\n<p><span style=\"font-weight: 400\">While urgent measures have increased the number of staff during the crisis, when the dust settles we are likely to have an exhausted and in some areas traumatised workforce. Pushing them as hard as we did before without worsening the already serious problems with retention and <\/span><a href=\"https:\/\/www.gponline.com\/surge-early-gp-retirements-3500-leave-five-year-period\/article\/1690178\"><span style=\"font-weight: 400\">early retirement<\/span><\/a><span style=\"font-weight: 400\"> would be almost impossible. It is difficult to think of a worse moment to begin an acrimonious war over pay\u2014yet a small increase is almost all that is possible with a core funding increase set at almost the same <\/span><a href=\"https:\/\/www.legislation.gov.uk\/ukpga\/2020\/5\/section\/1\/enacted\"><span style=\"font-weight: 400\">as was planned before the crisis<\/span><\/a><span style=\"font-weight: 400\">. The <\/span><a href=\"https:\/\/www.hsj.co.uk\/workforce\/severe-risk-of-doctors-cutting-hours-or-retiring-early-after-tax-relief-frozen\/7029611.article\"><span style=\"font-weight: 400\">freezing of tax relief on pensions<\/span><\/a><span style=\"font-weight: 400\"> will also add to the anxiety about a loss of senior staff.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/research\/understanding-the-impact-of-brexit-on-health-in-the-uk\"><span style=\"font-weight: 400\">drying up of international migration<\/span><\/a><span style=\"font-weight: 400\"> for the best part of a year due to Brexit, and its <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/news-item\/migration-changes-will-be-a-disaster-for-social-care-unless-government-introduces-special-route\"><span style=\"font-weight: 400\">intentional blocking off<\/span><\/a><span style=\"font-weight: 400\"> for social care on January 1st, will likely worsen the situation in raw numbers.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The Budget does repeat the \u00a33 billion in NHS \u201crecovery package\u201d funding announced in last year\u2019s <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/spending-review-2020-documents\/spending-review-2020\"><span style=\"font-weight: 400\">Spending Review<\/span><\/a><span style=\"font-weight: 400\">. But this is one-off spending for what is likely a long term and much larger problem. In addition to the problems of long covid and the health impact of a struggling economy, it is not clear how the NHS can catch up on the activity missed during the pandemic, which is fast storing up work for the future.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For example, just between April and November there was a 59% drop in planned orthopaedic inpatient admissions,<\/span> <span style=\"font-weight: 400\">and there was a significant fall in most other specialties as well as in CT, MRI, and other <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/news-item\/nhs-performance-summary-november-december-2020\"><span style=\"font-weight: 400\">diagnostic<\/span><\/a><span style=\"font-weight: 400\"> investigations (and this in the context of the diagnostics waiting target already not having been met for seven years). None of the proposals allow for the additional costs and productivity loss associated with covid-19 becoming endemic, nor do they recognise the lesson that running the NHS at such high levels of intensity carries very high risks.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">If the Budget had too little to say about the future for healthcare, it was entirely silent on social care. The sector was already in a desperate state, simply <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/research\/social-care-the-action-we-need\"><span style=\"font-weight: 400\">not offering any help<\/span><\/a><span style=\"font-weight: 400\"> to tens of thousands in a high state of need. Every aspect of it needs an urgent overhaul. The funding level is <\/span><a href=\"https:\/\/www.adass.org.uk\/adass-budget-survey-2020-coronavirus-budgets\"><span style=\"font-weight: 400\">too low for councils to meet their legal obligations<\/span><\/a><span style=\"font-weight: 400\">; the means and need-testing system is unfair and arbitrary; providers are dropping over the cliff edge of financial survival without <\/span><a href=\"https:\/\/www.nuffieldtrust.org.uk\/news-item\/responding-to-covid-19-the-underlying-complexities-of-the-social-care-provider-market\"><span style=\"font-weight: 400\">anybody clearly responsible for overseeing them<\/span><\/a><span style=\"font-weight: 400\">; and the workforce is underpaid, uncared for and too small.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet as we approach two years since the <\/span><a href=\"https:\/\/www.gov.uk\/government\/speeches\/boris-johnsons-first-speech-as-prime-minister-24-july-2019\"><span style=\"font-weight: 400\">prime minister promised to implement<\/span><\/a><span style=\"font-weight: 400\"> an already worked-up plan for reform, the term is not mentioned once in the long Budget document, other than as part of the DHSC\u2019s title. Nor did it feature in any substantial way in the recent White Paper.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Some of the rhetoric seems to imply that we are turning a corner. But with renewed austerity, a long haul for the NHS, unresolved issues in social care and pressures on staff, there is still an awful long way to go.\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Nigel Edwards<\/strong>, CEO Nuffield Trust.<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.\u00a0<\/em><\/p>\n<p><em><strong>Acknowledgements<\/strong>: Thanks to Mark Dayan, policy analyst, Nuffield Trust.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Budget had too little to say about the future for healthcare and was entirely silent on social care, writes Nigel Edwards, CEO Nuffield Trust Last week\u2019s Budget took place [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/10\/recovery-from-covid-19-relies-on-nhs-staff-yet-last-weeks-budget-had-little-to-say-on-health-or-social-care\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":49779,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-49778","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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