More money for the NHS is necessary but pressures on other public services risk our long term well-beingby Anita Charlesworth and David Finch / March 19, 2019 / Leave a comment
In his spring statement last week the chancellor tried to paint a picture of the sunlit uplands that beckon beyond Brexit; a public spending dividend of billions, which will finally mark an end to a decade of austerity. Assuming some orderly way forward on Brexit is found, this summer the Treasury will kick off a spending review to map out our post-austerity, post-groundhog-day future.
This spending review has big issues to address. Not least how to ensure the health and wellbeing of the population. The 2020s will look very different to the 2010s; the ageing of society will really start to hit the public finances and inequality is on the rise again.
The demographic reality is daunting. Around 40 per cent of all public spending goes on pensions, health and social care. Over the last decade the government checked some of the spending growth by raising the pension age. The same period has seen an increase in employment among older workers. But baby boomers are starting to retire. Over the next decade fiscal pressures will really start to mount; the numbers over pension age are set to increase by 1m over the next five years alone.
Added to this, we are not ageing well. What really drives NHS demand is how healthily we age. Sadly, many more of us have long-term chronic health problems and among older people, “multi-morbidity” is increasingly the norm. All of which makes managing people’s care increasingly complex and costly. It also means that people don’t just need good hospital care, more and more need social care support to eat, wash, dress and enjoy some quality of life. This presents a major issue for the public purse—age-related spending demands are ramping up.
Services are under extreme pressure and satisfaction with the NHS has fallen sharply to reach its lowest level since 2007. The government has already promised an extra £20.5bn for NHS front line services. While the Treasury would hope this is job done and it can shift its attention elsewhere in the Spending Review, this would be wrong. The extra money failed to address social care, excluded funding to train more health care workers and provided no money for public health budgets which are targeted at keeping people healthy in the first…