Autumn Budget 2017: A step back from the precipice for the NHS?

Wednesday’s Budget felt like one of the most eagerly awaited in years. With a government still reeling from a disappointing election result and embroiled in painstaking Brexit negotiations the stakes were high. A good budget might restore some hope and optimism, an unpopular one would heap further pressure on a government in need of a lift.

Judging by the Chancellor’s joke-filled start you could be forgiven for thinking that the outlook was going to be rosy. Sadly, predictions of flatlining productivity and slowing GDP growth started to pervade his speech. The mood changed faster than you could say ‘fit for the future’.

But with such doomsdayish forecasts, what would this all mean for health and social care? At Health Foundation HQ our antennas were on high alert.

Last week we and colleagues from the Nuffield Trust and The King’s Fund called for an extra £4bn for the NHS to fill the funding gap to stop patient care deteriorating next year. We also highlighted a £2.5bn funding gap for social care by 2019/20 and made the case to reverse planned cuts to public health budgets.

And what about the provider perspective? Glen Burley, CEO of South Warwickshire Foundation Trust and Wye Valley NHS Trust, wrote in a blog on Budget day that he wondered whether the continuing success of the NHS, despite all of its challenges, has contributed to the ongoing hard line on funding. But his fundamental question was, do we increase the funding or reduce the offer? A sentiment not dissimilar to Simon Stevens’ speech a week earlier.

So, the outcome? ‘Exceeded expectations – more, but not enough’, as our Director of research and economics Anita Charlesworth put it. A pledge of an additional £2.8bn to the NHS in England for day-today services (£350m immediately for this winter, £1.6bn for 2018-19 and the rest in 2019-20). Based on our estimates it is around half of the £4bn of spending pressures facing the service next year. Anita added in response that ‘The NHS was staring over a precipice - this is an important step away from the edge.’

One thing is clear is that the NHS received considerable attention in this week’s Budget. Anita wrote in Prospect magazine that against a backdrop of funding pressures Philip Hammond knew that sticking to his predecessor’s NHS spending plans was a risk not worth taking. In another piece for The BMJ she outlined the stark economic backdrop to the funding debate outlined in the Budget. Reminders of the pressures ahead were issued, not least on the growing workforce challenges.

Despite the notable pledges in the Budget, a future funding shortfall is very real, meaning key questions still remain. What will this mean for waiting times? Or improvements to mental health and cancer services?

To get to grips with the true reality it would be wise to listen to the post-budget analysis discussion held with the BMJ this week. Anita joined Professor John Appleby, director of research and chief economist at the Nuffield Trust and Siva Anandaciva, chief analyst at The King’s Fund. Much was dissected including the £10bn capital pledge, whether the £350m will make a difference this winter, and why social care was completely absent. Or similarly you could read their neat analysis in HSJ. And if you are interested in what the budget means for the amount we spend per person, look out for more analysis over the next few days before our spreadsheets get put away for a while. It’s valuable insight and will help to navigate a debate that is not going away any time soon…

Pete Stilwell (@pstilwell) is Senior External Affairs Manager at the Health Foundation