The government is giving with one hand and taking away with the otherby Anita Charlesworth and Hugh Alderwick / January 7, 2019 / Leave a comment
After nine years of austerity, 2019 is the year of extra funding for the NHS. Back in June 2018, the prime minister marked the NHS’s 70thanniversary with a pledge to increase health service funding by £20.5bn above inflation over five years. A new long-term plan on how to spend the money was launched on Monday with commitments to improve mental health, cancer and maternity care.
For the NHS and its patients, the extra money can’t come soon enough: services are struggling at or beyond full capacity, waiting lists are above four million and growing, and performance targets are being missed all year round.
But the government shouldn’t consider this “job done” on the NHS. Far from it. The £20.5bn gift for the NHS—while welcome—is not as generous as it first sounds. Health care spending is a constantly moving target: as the population grows, ages, and develops more chronic diseases, extra funding is needed just to stand still. The additional funding promised by the government is simultaneously a lot of money and too little. £20.5bn by 2023/24 is an average annual increase of 3.4 per cent in real terms for front-line services—below the historic average and just about enough to keep pace with growing demand, estimated at 3.3 per cent a year. So, maintaining NHS standards—let alone meeting the raised public expectations that come with extra funding and the long-term plan—will be a challenge.
The government is also making the NHS’s job harder through persistent policy failures in three key areas: public health, workforce and migration, and social care.
First, the prime minister’s £20.5bn funding announcement for the NHS excluded public health (which includes health visiting, stop smoking support, drug, alcohol and sexual health services). Public health budgets have faced persistent cuts in recent years. The core public health grant has fallen by 25 per cent per person since 2014/15. From April 2019, the grant is to be cut by a further £240m in real terms. This is despite public health interventions being some of the most cost-effective ways to improve health, and prevention being a stated government priority. Decisions on longer-term funding are for the 2019 Spending Review, but without significant additional resources we risk missing another chance to improve people’s health and are storing up problems for the NHS.
Second, years of policy…