On Thursday (17 November) the Chancellor told MPs he was able to show compassion in his Autumn Statement to those struggling the most because of the “discipline” his party had shown since 2010. Jeremy Hunt reasoned that because of austerity, the country can now afford to support those who are struggling. As a public health doctor, I would refute this assertion. My colleagues and I know that it is precisely because of austerity that so many people are struggling.
We see the clear evidence of the link between increasing numbers of people being unable to meet their basic needs, together with inadequate funding of public services, and people becoming ill or experiencing a worsening of existing health conditions. Austerity has contributed to the lowest levels of life expectancy in England in a decade and a huge and widening gap in health inequalities between the country’s most and least deprived areas. This Autumn Statement was a missed opportunity to address this terrible impact of spending cuts on health and social inequalities, worsened by the pandemic and at a time when the cost-of-living crisis is already accelerating this downward spiral. Put simply, the population is getting sicker, we can’t afford it and it doesn’t need to be this way.
There is an urgent need for a focus on the underlying causes of ill health to drive policy, but we’ve seen a decade of cuts to the essential public services that protect our health and the white paper on health disparities appears to have been scrapped. In 2021-22 budgets for day-to-day spending in local government, which funds the vital determinants of health, such as decent housing, were just 41 per cent of what they were in 2007-08 in real terms and now council leaders say that bigger council tax rises will not prevent more cuts to services. Since 2015-16 the local authority public health grant has been reduced by almost a quarter per person in real terms, resulting in drastic cuts, for example to health visitors (37 per cent), smoking cessation (41 per cent), adult drug and alcohol services (28 per cent) and sexual health services (23 per cent). The cuts have been largest in places with the greatest need. These are the sort of statistics that led the Glasgow Centre for Population Health to estimate that an additional 335,000 deaths had been caused by austerity in the five years before the pandemic – more deaths than from two and a half years of Covid-19.
Colleagues in GP surgeries and hospitals are dealing with the fallout of these cuts: young people feeling suicidal because they are about to be made homeless; older people with increasing frailty, without access to social care; an epidemic of children with mental health problems; and growing parental anxiety over how to meet housing, energy and food costs.
Doctors certainly welcome the extra funding promised for the NHS and social care, at a time when demand and pressures across the health and care system have never been greater. Unfortunately, the measures announced in the Autumn Statement will not offset the physical and mental health impacts of reduced living standards already being experienced by most people because of soaring prices. Health and social care workers now face the human cost of further wage erosion, higher unemployment and a greater tax burden, and public services, including healthcare, under ever-increasing pressure, staffed by an exhausted workforce, with record levels of low morale.
The British Medical Association supports the raising of benefits in line with inflation and targeted financial help with bills for the most vulnerable during the energy crisis and we welcome the increase in the national living wage. However, we still have one of the weakest social security systems among the countries of the Organisation for Economic Cooperation and Development. The government has rightly given some additional funding to health, social care and schools but leaves other departments to absorb the effects of higher inflation within unchanged allocations. This represents additional budgetary pressure that could fall anywhere between £5bn and £15bn by 2024-25. That is a huge cut to public services and a serious threat to the public’s health.
We need much more than last week’s pledges. We want to see considered long-term thinking, reflected in measures which will build an inclusive, sustainable and fair economy. Improving the population’s health means tackling health and social inequalities at source; not doing so is the biggest false economy of all.