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Autumn budget a missed opportunity for NHS, say experts

Autumn budget a missed opportunity for NHS, say experts
By Victoria Vaughan, Anna Colivicchi and Eliza Parr
23 November 2023

The government has ‘downgraded’ the NHS in the mini budget and ‘failed to recognise the connection between the health of the nation and its prosperity’ according to policy experts.

The Autumn Statement allowed for a two-percentage-point cut to Employee National Insurance from 12% to 10%, reform to the fit note process and an increase in the National living wage by 9.8%.

In the statement speech Chancellor Jeremy Hunt said: ‘We are nearly doubling the numbers of doctors and nurses we train, having given the NHS its first ever long-term workforce plan, as I promised to do a year ago. We are also tackling the greatest single preventable cause of mortality the NHS has to deal with by bringing forward plans for a smokefree generation. But alongside extra funding and support, we need to see reform. We need a more productive state not a bigger one.’

However, experts have criticised the statement for a lack of both the recognition of the challenges the NHS faces and the funding required to tackle them.

The NHS Confederation’s director of policy, Dr Layla McCay, said that the Autumn Statement, announced yesterday, is a ‘missed opportunity’ for Chancellor Jeremy Hunt to get the NHS back on track following the impact of strikes on patient care and ‘already-tight budgets’.

Dr McCay, said: ‘The government has been clear in its messaging that this mini budget was to be a plan to drive economic growth yet in downgrading the NHS as a priority, it has failed to recognise the important connection between the health of the nation and its prosperity.

‘The NHS has been hit with this blow as waiting lists for treatment continue to rise, there is increasing long-term sickness in the community and frontline services are bracing for a very challenging winter period’.

Nuffield Trust deputy director of Policy, Natasha Curry, said: ‘With barely a mention for the NHS and social care in [yesterday’s] Autumn Statement, it would seem the government is neglecting the gravity of the financial challenge facing health and care services.

‘As we have shown this week, the NHS budget is in a precarious state, currently staring down a £1.7bn deficit. To plug this gap the NHS has been forced to scale back additional efforts to clear record waits and initiatives to improve patient services.

‘The NHS budget next year is set to flatline; it will be nearly £4bn below where it would have been if increases promised before Covid continued, which will deal a blow to planning and work on the productivity improvements the government wants to see.’

The Autumn Statement included a two-percentage-point cut to Employee National Insurance from 12% to 10% which will come into effect from January next year.

According to the statement, a junior doctor on £63,000 will receive an annual gain of over £750 thanks to the cuts, while a senior nurse with five years of experience on £42,618 will receive an annual gain of £600.

Mr Hunt said: ‘I’m going to cut the main 12% rate of employee national insurance – if I cut it by one percentage point to 11% that would be an extra £225 in the pocket of the average worker every year.

‘But instead I’m going to go further and cut the main rate by two percentage points from 12% to 10% – that change will help 27 million people.’

The King’s Fund chief analyst Siva Anandaciva said that the Autumn Statement ‘appears to have offered nothing significant beyond the relatively small amount of additional funding for the health service recently announced, which we cannot pretend will be enough for the NHS to do everything needed to give patients the care they deserve and expect this winter’.

‘The Government’s NHS funding announcements have now become caught in a vicious cycle of inefficient emergency cash injections and unrealistic expectations of what the NHS can deliver in return.

‘To avoid the NHS facing a crisis every winter, ministers need to make long-term decisions that can bring demand, capacity, and efficiency back into better balance,’ he added.

It was also announced as part of the statement that the Government is taking steps to reform the fit note process to support more people to resume work after a period of illness, as well as expanding the NHS Talking Therapies programme.

The Statement also confirmed that from April next year the national living wage will increase by around 9.8% to £11.44. 

Currently, the national living wage for those aged over 23 is £10.42, meaning the rate will rise by more than £1.02 – and will now cover 21 and 22-year-olds for the first time. 

The BMA’s GP Committee in England said that while the increase is a ‘good thing’, the Government must ensure ‘struggling practices’ have adequate funding – otherwise more of them could face closure.

In its announcement, the Government said this is the ‘biggest cash increase’ to the minimum wage in over a decade and meets the manifesto pledge to ‘end low pay’.

County Durham GP Dr Kamal Sidhu told sister title, Pulse, his practice staff work ‘very hard’ and deserve to be ‘well remunerated’ – but he believes the Government is ‘creating a divide between GP partners and their staff’ by not providing sufficient funding.

He said: ‘Increase of minimum wage is very welcome but it must be accompanied by increased funding for the practices. Uplift in the wages requires differentials for other staff to be maintained too. 

‘Practices are already feeling a massive squeeze with increase in staff costs, energy bills and maintenance costs. This is hugely exacerbated by significant cuts in practice support and funding.

‘All we hear now from ICBs and local authorities is that there is no funding in the NHS for practices.’

Dr Pipin Singh, a GP partner in North Tyneside, said it will ‘have to be thought through how that will be funded by the Government for GP practices in the global sum’. 

He told Pulse that although his practice was able to give salaried staff the recent 6% uplift, there is ‘no doubt’ this national living wage rise will ‘have an impact on finances’.

Earlier this year, the Government accepted a pay review body recommendation for a 6% pay rise for NHS staff and, following negotiations with the GPC, the global sum for GP practices was increased from £102.28 to £104.73 to cover this uplift. 

However, many GPs were concerned that this uplift was not adequate to pass on the 6% pay rise to all staff.

A version of this story first appeared in sister title Pulse.

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