The chancellor found cash for the NHS down the back of the settee, but cuts to social care may come back to haunt him

Time flies so fast in our spinning, 24/7 world that George Osborne’s 25 November autumn statement seems an age ago – even further back than Jeremy Hunt and the junior docs’ last minute lurch away from that strike, and back to the negotiating table neither party should have left.

‘Osborne must have decided that he dare not risk a public row, let alone St Simon’s resignation’

But it’s the event that handily discovered £27bn worth of hypothetical revenue down the back of the Treasury sofa – money overlooked when the sofa covers were washed in July. So it is the one that will shape the coming year’s politics on the domestic front, not EU talks, terrorism, or their offspring, refugees.

NHS finance directors were duly grateful for their upfront £3.8bn share, albeit more to Simon Stevens – now such a public celeb that he appears on Radio 4’s Any Questions? (can Desert Island Discs be far behind?) – than to the sceptical chancellor. Osborne must have decided that he dare not risk a public row, let alone St Simon’s resignation, at the start of a nailbiting winter for debt-laden trusts. Some are on the edge of bankruptcy already.

Sofa, not so good

Osborne’s hyped package not only rested on the risible, convenient sofa billions (they depend on revised assumptions about heroic growth and tax receipts up to 2020), they included some tough cuts elsewhere in the health and social care network, which may return to haunt him as much as the magic sofa.

‘Cuts to public health budgets are popular with politicians because they leave no obvious bruises’

Localising the business rates tax may be proper devolution by an over-centralised UK, but it will benefit better off areas, not poorer ones. The 2 per cent “social care precept” that councils were graciously given permission to raise – along with the blame – carries the same problem and will not close the funding gap.

One of the more shocking things I heard was that private equity buccaneers like Guy Hands of stricken Four Seasons care home fame deemed that a triumph. He had been lobbying Osborne for the 2 per cent so that councils could afford to pay more to help bail out care homes. Yet council and NHS budgets are squeezed by a higher minimum wage and pension changes, too.

Cuts to public health budgets are self-evidently shortsighted, but popular with politicians because they leave no obvious bruises: just fat, pregnant, ill people down the line. We could say the same about the latest retreat on climate change policy, but not here. I sympathise with governments improvising in hard times, but not much when vast amounts of unearned wealth goes so lightly taxed.

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As always in Britain’s modern blame culture, who carries the can? Easy peasy, where nurses’ bursaries are being replaced by loans that their salaries will be hard-pressed to pay off unless they leave the NHS’s payroll and return to the same wards as less popular – but much better paid (“three times as much,” one told me recently) – agency nurses.

If I understand official data on the growing number of junior docs dropping out correctly (48 per cent?), some disgruntled medics may be having similar thoughts.

‘The docs should be careful not to push their industrial luck’

Ministers are always blamed for nurse manpower problems, but does The Angel Factor also apply to the docs? Minister Hunt took the instant “climbdown” hit for withdrawing – at least for now – his threat to impose the new contract so that talks could continue. The conciliation service, ACAS, is the one bit of 70s industrial relations reform Maggie was persuaded to retain, against her worst judgement. It even survived coalition cutters in 2010.

But BMA negotiators withdrew their strike threat, albeit at the cost of cancelled operations (20,000?) and the anger of medical militants. They now concede the need for a contract that addresses the NHS’s weekend mortality spike (16 per cent?). It’s a problem they dismissed when Hunt used reputable data against them. So that’s a plus for him.

Both sides make valid points and Hunt’s confrontational bedside manner has been privately criticised by many health grown-ups: the buck stops with him. But the docs should be careful not to push their industrial luck at a time when all but investment bankers are suffering, snow is falling, flood levels rising and waiting times lengthening.

Public opinion can be irrational: voters disapprove of the better type of GPs, the ones who refuse them antibiotics for their own good, so a new survey reveals. Voters know juniors sometimes work long hours; it was an issue in the hospital doctors dispute with Barbara Castle in 1975, the year of ACAS’s birth. But it is not irrational to doubt “exhaustion” claims from their angry spokesman, Dr Johann Malawana, after the Mail on Sunday revealed, with characteristic efficiency, that he runs a weekend wedding photography agency. Weddings are hard work too.

In the struggle to make NHS systems work more effectively in budget constrained times, good people do smarter things every day. Excellent. But they do so in the context of a less elevated propaganda war all sides should acknowledge.

Michael White writes about politics for The Guardian