RCP president Professor Andrew Goddard reflects on what was – and wasn’t – announced in this week’s Budget.
This week’s Budget unsurprisingly focused on the immediate challenge of supporting businesses and protecting jobs, before the vaccine rollout returns us to a semblance of normality.
The lack of any long term commitment to tackling the key challenges facing the NHS and social care was noticeable and disappointing (albeit predictable). In the March 2020 Budget document, the NHS was mentioned 35 times. In this week’s, that number was just 10.
The £1.7bn funding announced by the Chancellor to support vaccine deployment should remind us that there is light at the end of the tunnel. While the last Budget was delivered less than two weeks before the Prime Minister’s ‘stay at home’ message, we are now looking to emerge from this crisis.
To prepare for the threat of future pandemics and new coronavirus variants, £22m of funding was also announced for new vaccine studies (including a trial combining different vaccines), and £28m to increase the UK’s testing capacity.
Dealing with the backlog
Given the huge volume of patient demand that has built up in the past year, the £2.5bn announced in November’s spending review to tackle backlogs looks a little light. As the Office for Budget Responsibility said yesterday, “the Government will also need to decide how to catch up on services disrupted by the virus, notably the backlogs in nonurgent procedures in the NHS that have built up”.
Not taking that decision yesterday could prove costly. The backlog may well be largely nonurgent care, but patients will quickly become frustrated if they are unable to get the treatment they need once the vaccine has done its work and the pressure on the NHS eases.
Workforce
Staffing levels were inadequate prior to the pandemic, and the last 12 months have seen the workforce stretched to its limit. Physical and emotional reserves are running low – recent RCP member surveys have found half are not getting enough sleep, 29% had sought mental health support and a third of trainees had reconsidered medicine as a career.
An important part of the NHS service recovery will be staff recovery, or we will have even less hope of tackling the backlog and returning the NHS to an even keel. But ultimately the solution is a commitment to increasing the number of clinicians. We need Ministers to commit to doubling the number of medical school places if the health service is going to meet the demands of the future.
Social care and public health
The other missing piece was a commitment to invest in a truly preventative healthcare system by tackling the £6.8bn funding gap for adult social care and public health. A properly resourced social care sector would ease the pressure on hospitals by reducing the number of people who need to be in hospital in the first place, and make it easier for them to leave more quickly. More detail has been promised on social care reform this year, which we eagerly await.
The lack of investment in public health is also particularly disappointing, given we know that poor underlying health is one of the main reasons the UK is suffering worse than most from COVID-19. This is illustrated starkly by the new evidence that 30% of COVID-19 hospitalisations in the UK are directly attributable to obesity and overweight.
As the government considers welcome proposals to move towards a more integrated approach to delivering healthcare, it also needs a more joined-up approach to tackling health inequalities. It would be a mistake to think that the Department of Health and Social Care or the soon-to-be live National Institute for Health Protection can face this challenge alone.
The pandemic has clearly highlighted that the causes of poor health are many and varied. As the government’s own research shows, it is ‘a range of socioeconomic and geographical factors such as occupational exposure, population density, household composition and pre-existing health conditions’ are behind the different mortality rates among ethnic groups. These issues were a problem before the pandemic, and will remain without decisive action and investment. The solution cuts across government departments so it’s essential that we have a coordinated cross-government strategy to reduce health inequalities.
The Chancellor’s pledge to “do whatever it takes” must go beyond projecting jobs and livelihoods. It must include protecting the future health of the nation by investing in our healthcare workforce, social care and public health, and delivering a coordinated approach to reducing health inequalities.