Thoughts on the Spending Review

Anita Charlesworth, Director of Research and REAL Centre, the Health Foundation  

More money is going into the NHS, but more doesn’t necessarily equate to enough: ‘There’s a huge amount of uncertainty about how the backlog in elective care will play out. We’re missing around 8 million people who we would have expected to come forward for care throughout the pandemic. If 75% of those people come forward and we were to aim to get back to the 18 week standard by the end of this Spending Review period, then we estimate this would cost something like £17bn. In this settlement there is provision to spend £10bn on the elective care backlog. If patients reappear in the numbers we expect, then it’s not enough to make any sort of inroad into the current size of the waiting list.’ 

Questions around workforce capacity have been left unanswered: ‘All of this money is good news but it can’t achieve anything unless we can recruit and retain the staff that we need. COVID-19 has shown that we have huge capacity issues in our system and these are legacy capacity issues. This settlement doesn’t address how we’ll tackle fundamental issues around capacity in the longer term, so that we’re not left in this kind of situation again.’ 

Capital spending increases will need to be sustained: ‘The significant increase in capital spending is beneficial but we need to be realistic about what it can achieve. There’s a legacy of underinvestment and a maintenance backlog of over £9bn. So it is good news, but far from a panacea. If it is to make a difference it’ll need to be sustained for a very long time.’ 

Saffron Cordery, Deputy Chief Executive, NHS Providers 

Tackling waiting lists is only one of the challenges we face: ‘What we have seen is massive national prioritisation of cutting the waiting lists. This is totally understandable and really important – however it’s not the full picture. Looking only at elective waiting lists misses some big challenges in terms of pressures facing the urgent and emergency care pathway across the NHS, and the pressures facing mental health and community services. Reducing the backlog is important and critical for those waiting for procedures, tests and other interventions – but we have to remember that there are all sorts of challenges alongside that.’ 

We still need to see investment in workforce planning: ‘A fully-funded workforce planning budget is critical and we didn’t see this in the Spending Review. The workforce challenges we’re facing in the NHS are nothing to do with COVID. COVID simply exacerbates them, they predate COVID. The level of vacancies of around 9–10% that we see across the NHS have been baked in for a significant period of time. Put simply, without the people, we cannot deliver the services. If we’re not going to invest in a plan to have that supply of people then we are genuinely hand to mouth.’  

Sarah Pickup, Deputy Chief Executive, Local Government Association 

More funding is needed for public health: ‘There’s no real-terms increase in public health spending. It’s hard to see how this supports the drive to reduce health inequalities and improve public health which is the heart of the purpose of every Integrated Care System. Not increasing investment in public health seems counter to that intention.’ 

Existing pressures have been overlooked: ‘At the LGA we estimate that forward pressures in social care – so looking at what’s happening next, rather than what’s happening now – will need around £2.5bn per annum. Adult social care will account for around £1.1bn per annum of that. With the funding that’s been announced, these forward pressures will be met in years 1 and 2, but about £1bn short in year 3. And there’s nothing at all to address the “here and now” problems such as the challenges around domiciliary care. It’s not enough to improve the system. The existing pressures are not being addressed.’ 

David Finch, Assistant Director of Healthy Lives, the Health Foundation 

Maintaining the public health grant in real terms alone won’t meet future pressures: ‘The public health grant will be maintained in real terms over the spending review period. That’s better than it has been since 2015/16, when we started seeing successive years of real terms cuts. But our analysis shows that maintaining the grant in real terms alone won’t meet expected future pressures from demand and costs. Some of those pressures come from wage growth and some from underlying trends such as increasing drug and alcohol deaths and a rise in obesity. Projected rises in child poverty will also have an important effect on demand for things like children’s services.’ 

The importance of cross-government working on public health: ‘When people talk about health being a priority, it tends to be about the NHS. But what will be important now is effective coordination across government departments to improve health. It has to go broader than just certain acute health issues and look at public health too. What we need to see is broad cross-government action on trying to keep people healthy.’ 

Watch a recording of the webinar to explore the discussion in full. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.