The Autumn Statement has come at a time when almost every part of the NHS is under extreme stress and with the same or worse facing social care. In response Jeremy Hunt, the Chancellor, announced on 17 November that he has found £3.3bn a year extra for the NHS and up to £4.7bn for social care by 2024-25. At a time when other public services are taking cuts, this represents significant additional cash and will go some way to meeting the most immediate concerns.
With his specific focus on social care and its workforce, it’s clear that the Chancellor has gained insight and understanding from his time as chairman of the Health and Social Care Select Committee into the heart of Treasury thinking. Hunt has finally committed the government to produce proper workforce plans for the NHS, with independently verified projections for the staff needed over the next five, ten and 15 years – a welcome step coming after the government had strongly and somewhat bizarrely resisted such calls for over a year.
This should start to fill what was easily the biggest gap in government policy towards the NHS and gives England its best chance to date of escaping the repeated workforce crises that have plagued the service in recent years. The fact that this commitment doesn’t extend to the social care workforce, however, is a disappointment.
Additional money for social care – while significant in scale and very welcome – has come, in part, at the expense of delays to the long-term plan to reform funding that was a key part of Boris Johnson’s legacy and a Conservative 2019 manifesto commitment. This delay will leave many thousands of families still facing high bills for social care over the next two years. Many in the sector will worry that delay may eventually lead to abandonment – after all, it was Hunt who, as health secretary, announced a delay to social care reforms in 2015, kicking it into the very long grass for Johnson to pick up in 2021. While proceeding with reform would have been preferable, at least the money saved is staying in the sector to help with current pressures and hasn’t been gobbled up by the “fiscal black hole”.
Although this funding package is positive relative to other public services, it still leaves a financial headache for many in health and social care. While capital budgets have not been cut, neither have they been raised in line with inflation. This means plans to upgrade the NHS’s crumbling estate and buy much-needed new equipment such as scanners and better IT will have to be pared back.
In finding additional funding for the NHS and social care, the Chancellor is clearly gambling that the cash can begin to make improvements that the public will notice before the next election. The focus on social care investment to reduce delayed discharges from hospital promises to slash ambulance waiting times, and a recommitment to bringing down waits for planned care demonstrates a desire to get service access and patient flow working much better. Expect ruthless focus on these areas, but little progress in other areas of the sector.
While the financial settlement is better than many expected, this of course still leaves the NHS and social care facing the immediate challenge of the most difficult winter in its history, added to the possibility of industrial action by nurses and other healthcare workers over pay. The Chancellor may have provided some emergency support but there are still significant challenges ahead.