Responding to chancellor Jeremy Hunt’s Autumn Statement, which pledged that the NHS budget would increase by £3.3 billion per year for the next two years, think tanks The King’s Fund and Nuffield Trust and care sector organisation the National Care Forum [NCF] give their views on what this will mean for the health service and social care.
Within the Autumn Statement, Hunt committed £3.3 billion in additional funding for the NHS over the next two years and postponed the implementation of the lifetime social care cap for two years.
The lifetime cap, originally due to enter force in October 2023, stipulates that no individual will pay over £86,000 in their lives for the care that they receive. On top of this, local authorities in England will be handed powers to increase council taxes by up to five per cent per year without having to consult local residents in a vote. This will extend the powers that councils have to bring in more tax revenue for social care and other budgetary requirements.
Richard Murray, chief executive of The King’s Fund think tank, welcomed the government’s commitment to increase funding for the health service, but warned that the scale of resources promised would command healthcare leaders to be selective with where the funding was channeled.
Murray said: “The additional £3.3 billion funding for the NHS budget is important recognition from the government that the health service is on its knees trying to meet demand and keep patients safe. However, with NHS funding on a knife-edge, it will force the service to focus solely on its top priorities and go further on an already ambitious efficiency programme.”
While Murray acknowledged that capital funding has been protected in cash terms, he warned that the effects of inflation would mean that ministers and health leaders would likely need to scale back plans for the maintenance and upgrading of NHS buildings, equipment and IT.
Murray continued: “We warmly welcome the chancellor’s commitment to a workforce plan with independently verified projections for staff numbers over the next 15 years which means that health and care services can plan to train, recruit and retain the staff they need in future. We hope the necessary resources will also be put in place to meet these needs.”
Nigel Edwards, the chief executive of the Nuffield Trust, was more critical in his assessment of the NHS budget, warning that the funding set aside by government falls short of the health service’s estimations of what was needed.
Edwards explained: “The NHS warned it needed more money to cope with the impact of inflation on its costs. The Autumn Statement has provided much-needed extra cash from April over the next two years, but this is only around half of what the NHS had warned last month would likely be needed.
“It also does not account for the £2.5 billion worth of inflation and other unexpected cost pressures the NHS has faced this current financial year.”
Edwards added that spending in real terms per head on healthcare after adjusting for age will only increase by less than one per cent over the next two years, compared to a long-term average of 2.6 per cent.
“This comes at a time when the NHS cannot afford to stand still and is desperately trying increase the work it can do to clear record waiting times,” Edwards continued.
Edwards went on to urge for greater clarity and decisiveness from ministers around workforce planning, calling for a “proper workforce strategy” to be implemented which ensures gaps in staffing are addressed in all services and all areas of the country”, rather than simple acknowledgement.
Addressing what the fiscal package would bring for social care, Murray warned that while postponing the lifetime cap and giving local councils greater leeway to raise tax revenue may help, other measures in the statement such as hikes to the national living wage, ongoing inflation and scaling back energy support from April 2023 would all further eat into social care budgets.
“Increases to the national living wage, hikes in energy prices and ongoing inflationary pressures will all add to social care providers costs,” Murray highlighted.
“It also remains unclear how much of the additional funding may have to come from council tax rises and where today's proposals leave local authority finances overall.”
Singling out the decision to postpone the lifetime cap, Murray referred to the move as a “disappointing” one.
He said: “What we do know is that part of this extra funding is coming from further delay to the much-needed reforms on how we pay for adult social care. This is disappointing and the delay to the extension to the means test and a new capped cost model will leave many thousands of families missing out on this promised new support.”
Commenting on social care measures, Edwards added that while local authorities have been handed powers to raise council taxes further without public consultation to raise more revenue, it was likely to place further pressures on normal people who were already struggling to adapt to rising prices, risking creating further inequality.
Critiquing the postponement of the lifetime social care cap, Edwards said: “The chancellor also confirmed that the social care cap will once again be delayed and the money diverted to keeping the sector afloat. This will come as a disappointment to families facing eye-watering costs for care.
“While the cap was never the silver bullet for reform, this delay risks losing the momentum that was growing towards real and long-awaited change to the sector. On top of this, delaying the policy of moving towards paying a fair cost to care organisations is missing an opportunity to develop a more sustainable market for care and risks undoing the progress already made.”
Assessing what the Autumn Statement means for social care at large, the National Care Forum’s [NCF] CEO, Professor Vic Rayner OBE, said that the fiscal package sent a message to the sector that it would be placed “on the back burner” for the remainder of the current parliament.
Professor Rayner said: “There is little in this budget that talks to the vision of developing care with people at its heart. Social care is about people, not packages and whilst discharge is vital, great social care changes lives and matters to us all, and it is imperative that over the next two years the government keeps its commitment to develop care that is fit for the future.
“All the money announced is of course hugely welcome as is the recognition that social care is vital and an integral part of the government’s public sector responsibilities. However, for the money to make a real difference it must address the fundamental inequities that people receiving care and working in the care sector experience every day. These relate to the pay, terms and conditions of the workforce, and access to the care that you want when you need it.
“It is right that our workforce deserves the increase in the national living wage and much more in terms of reward and recognition. However, to realise this, the government must set out how it intends to fund councils to meet the full costs of the national living wage increase for all of the care workforce. As having made a decision to delay the cap on care costs, and the introduction of a more generous means test, it would seem outside of the realms of compassion and fairness to require those funding their own care to continue to have to cross subsidise public sector care provision.”
Professor Rayner also declared that for the government to deliver on its ambitions of integrating care systems and services across the NHS and social care sector, it required ministers to make more concerted efforts to raise the status of the social care profession beyond simple acknowledgement.
“Fundamentally, care and support services are so much more than the ‘discharge arm’ of the NHS. The government must start to recognise this.
“If the integration of health and care is to mean anything to the people who need care and support, we need a reframing of the priorities. Of course, we must support people to leave hospital well and safely to regain their independence and wellbeing, but the government and the Integrated Care Systems must also focus on those who need care and support long term, those who need earlier support to avoid a crisis and the army of carers, both paid and unpaid, delivering great care every day.
“Whilst this is a welcome recognition of the importance of social care, much more is needed to put the sector on a sustainable long-term footing, support people where and when they need it and enable providers to reward the care workforce in the way they deserve.
“In the face of such a fundamental squeeze on public sector funding, now is the time, more than ever, to invest in sustainable not-for-profit care and support to support our communities up and down the country.”
Photo by Luke Jones on Unsplash
