The chancellor may be feeling good about the spending review settlement, but his lack of holistic vision leaves scant room for the creativity required for coming up with new ways of integrating public health
The comprehensive spending review is probably slightly better than expected in terms of health. The £3.8bn for NHS England is obviously welcome, but it doesn’t deal with the fact it’s a staging point to £8bn by 2020.
We’ve always rescognised that increasing spending to £8bn a year by 2020 is the very minimum needed, and nothing has changed. Delivering some of the funding front loaded will be helpful but doesn’t address the pressures.
‘It reinforces the view that governments are bad at holistic decisions on health issues’
On social care, the combination of the potential 2 per cent council tax precept and additional funding for the Better Care Fund – assuming all local authorities do the maximum available precept – will mean a modest real terms social care funding increase by the end of the period, but with a big squeeze in years one and two.
It may not be realistic for the Treasury to assume all will raise that 2 per cent. Again, this seems better than some worst case scenarios, but it ignores the consequences of demographic growth and an ageing, fattening population. It’s better than nothing but doesn’t solve the current social care crisis. And it looks as if there are real cuts to public health budgets.
Overall, it confirms that governments tend to follow traditional silos in spending reviews, acting more politically than economically, and don’t take account of the state’s role in public health and the determinants of health. It lets the chancellor look good, but reinforces the view that governments are bad at holistic decisions on health issues.
It leaves serious questions as to whether patients can access the care, support and treatment they need over the next few years. It’s going to be tough.
Enabling healthier living
There are some interesting implications of the progressive withdrawals from public health. Do we need to think of public health in a different way? It sounds as if the government distrusts traditional public health and is clearly not keen on “big stick” regulations.
‘Where is the space for the innovation, creativity and collaboration?’
What is the model for enabling people to get and stay healthy? This seems to signal a need to look for new, creative ways to do public health, as the powers-that-be distrust the traditional version of it. And many in our sector would say “let us help you engage with citizens to improve their health, because we can help”.
It also reinforces the need for creativity on NHS reform. We have a situation where the money is still very squeezed, for both health and social care. Frontline reality willl feel under huge pressure on finances, performance management, targets and budgets, and from the Care Quality Commission and regulatory bodies. NHS Improvement comes into this situation as a newcomer whose impact remains to be seen.
So there will be many people making frontline people “do stuff” about financial and quality targets as pressures continue to grow.
Where is the space for the innovation, creativity and collaboration that are clearly required? Will the new models of care and the Five Year Forward View vision prove to be a sufficient counterbalance?
Jeremy Taylor is chief executive of National Voices