What was announced?
An additional £2.8bn to the NHS in England over three years - This breaks down as: £350 million to assist the NHS to increase capacity this winter, £1.6 billion for 2018-19 which, alongside previous commitments, the government says will see the NHS resource budget rise by £3.75bn, and the remaining provided in 2020 to “help address future pressures.”
However, there are two things we should note about this funding. First, this additional funding is outside of the Spending Review process and so will be in the form of one-off payments. Second, there are strings attached. The Budget document stated: “This funding should be used to enable the NHS to meet the A&E four-hour target next year, make inroads into waiting lists and improve performance against waiting time targets.”
An additional ‘£10bn’ of capital funding for frontline services during this Parliament to support STPs - However, less than half will come from additional Treasury funding. The £10bn figure relies on the sale of NHS buildings and an increased use of private finance.
There will be no specific additional Treasury funding for a pay increase for Hospital Doctors: any pay increase will have to come out of NHS budgets – Although the Chancellor has been under pressure to make firm announcements on public-sector pay, he remained vague. He stated only that he would allocate additional funding for NHS staff on the Agenda for Change contract (including nurses, paramedics, and midwives) - and only if they signed up to changes to terms and conditions and the review body recommended a rise. Phillip Hammond made no pledge to support hospital doctors, and failed to acknowledge the crisis in staff recruitment and retention.
What the Chancellor did not mention:
- No mention of social care
- No mention of new funding for primary care or mental health
The Chancellor has not delivered
The Chancellor told the House of Commons that ministers recognised challenges facing the health service. He went on to state that it was “central to this government's vision that everyone has access to an NHS free at the point of need,” calling the health service one of the UK's “great institutions” and reiterating that this government “will always back it.”
However, the NHS is under acute pressure and the additional funding promised in the Budget does not go far enough to meet needs identified by NHS England itself. It remains likely therefore that the NHS will struggle to meet targets, and struggle to run services. Unless appropriate funding is provided, waiting times will continue to increase, staff shortages will grow, and the quality of care will deteriorate.
The Chancellor also did not address the issues of recruitment, retention, and pay. Over the past seven years real-terms wages have declined for hospital doctors. This goes alongside negative changes to pensions and increasing workloads. This has led an increasing number of hospital doctors to quit the profession or leave the NHS to work abroad. We called on the Chancellor to recognise these issues. However, he failed to do so.
In light of continued underinvestment we reiterate our call for the establishment of an independent body to assess long-term NHS requirements and propose the level of funding required to meet these needs.
This is a budget that does not put patient care first, does not support hospital doctors, does not address significant underfunding, and does not “back the NHS.”