While the 2023 Spring Budget was good news for wealthy people adding to hefty pension pots, informed observers appear unanimous in warning that Jeremy Hunt’s failure to increase revenue or capital allocations to the NHS will have serious consequences.

The Nuffield Trust’s Sally Gainsbury dismissed the budget in a press release of just five scathing paragraphs, noting:

““Just two weeks from the new financial year, the NHS has been left with an unrealistic budget for the year ahead.  …

Our analysis of DHSC spending and government inflation projections finds that today’s Budget leaves the NHS with a £2 billion real terms funding cut from April this year. The NHS has been left with little certainty over how it will meet growing demand or address a workforce in crisis.”  

She concludes: “It seems almost inevitable that the Chancellor will have to return to Parliament to address this in the not-too-distant future.”

The Health Foundation’s CEO, Dr Jennifer Dixon, also joins the consensus in warning

“Without a credible plan for expanding and supporting the health and care workforce over the long term, the NHS will struggle to recover services and improve care for patients.”

The NHS Confederation, representing both trusts and Integrated Care Boards also responded with warnings in a substantial report on the budget:

“There was … confirmation that there will be no increase in either the NHS capital or revenue budgets over and above what was announced in the Autumn Statement.”

The Confed is above all worried that its members will be stuck with the bill for whatever pay settlement is eventually agreed with agenda for change staff and junior doctors:

“First, we have yet to see a resolution to the ongoing pay disputes. As the 2022/23 pay award was not supported by additional funding, this came at the expense of other investment, including various digital programmes. …. We have been clear with government and in the media that any pay award above 3.5 per cent cannot be funded from within the existing budget without consequences.”

But of course the other huge issue is the continued absence of any plan to tackle the NHS workforce crisis, which on latest figures leaves 124,000 posts vacant. Again the Confed is unimpressed:

The long-delayed workforce plan has failed to materialise ahead of Budget Day. We are disappointed that it has been delayed once again. Today’s Budget presented an opportune moment to demonstrate the government’s commitment to funding long-term workforce growth.”

The Confed returns to the issue, noting that “Industrial action across the public sector is largely down to pay and conditions, but … many striking staff members in the NHS cited concerns over the quality of care that they were able to provide as a reason for walking out. … 

“Staff shortages are a key reason behind the industrial dispute and the imperative to offer hope to staff that workforce numbers will increase. They will be left discouraged today.”

Interestingly the Institute for Fiscal Studies director Paul Johnson went further on the failure to fund a settlement of the pay strikes, with an unusually sharp criticism:

“There was no funding to be found to improve the pay offer to striking public sector workers, where £6bn might have been enough to make an inflation-matching pay offer possible this coming year. That’s a political choice: money for motorists, but not for nurses, doctors and teachers.”

Another IFS commentator, Ben Zaranko, also raises concerns over the pay offer that has been made to NHS unions. Writing before the most recent inflation figures revealed the CPI once more increased to 10.4%, he argued that the offer would – on the basis of official forecasts  – give an increase for 2023-24 above predicted CPI inflation of 4.1%, but would still leave consolidated pay “up to 5% lower in the long run than it was in 2021-22.”  

Zaranko assumes that the one-off “bonus” lump sum for 2022-3 will “come from the Treasury,” but notes that there is no additional funding in the Budget to cover the 2023-24 award. He estimates that the additional 1.5% increase above the 3.5% which the DHSC had claimed was the maximum affordable increase adds an extra £1.5 billion to the pay bill.

“There must be a risk that the NHS is asked to make heroic efficiency savings to absorb these costs, struggles to do so, and instead has to be bailed out in 6 months or a year’s time. … it is unclear whether the Treasury will eventually provide the funding required to cover the cost of this deal. If it did, that would be a material alteration to the spending plans contained in Wednesday’s Budget before the ink is dry.”

NHS Providers, representing trusts and foundation trusts, published a pre-budget submission setting out a series of concerns, which also centred on the full-funding of any pay award:

“Trust leaders would like to see the government being proactive in negotiations with trade unions regarding industrial action and come to an agreed settlement. The government must do all it can to ensure that the costs of resolving industrial action regarding 22/23 pay awards are fully met and do not lead to cuts in health or NHS budgets.”

NHS Providers differs from Ben Zaranko, insisting in their response to the Budget that the assumed NHS pay increase is 2.1%, not 3.5%, and sounding the alarm on consequences if the eventual deal is not fully funded:

“As we continue to flag, the government must commit to fully funding any pay award uplift for 2023/24 taking into account the fact that an assumption of only 2.1% is accounted for within the current NHS budget and we expect any pay settlements to be higher. 

“It is important that government understands the potential impact on patient care should additional funding for a pay uplift be taken from within existing budgets. In this event, the NHS could be forced to make cuts to frontline services and reduce planned investment in primary care, mental health and cancer services.

NHS Providers, who have just published a hard-hitting report on the state of capital funding and allocations across the NHS, and their Budget response also focused on the desperate shortage of capital, noting:

“This Budget does nothing to address the wider need for capital investment across the NHS for providers of acute, mental health, ambulance and community services.”

Responding to LibDem research after the Budget which exposed the continued NHS reliance on ageing and outdated X-ray machines, CT scanners and radiotherapy machines, NHS Providers have been even more blunt:

“… years of under-investment in facilities across the NHS has left too many providers with inadequate buildings, failing equipment, such as old CT scanners and unreliable mobile X-ray machines, and an inability to adopt new technologies to improve care.

“Trust leaders were left sorely disappointed by the lack of an announcement on the New Hospitals Programme and the £10.75bn maintenance backlog facing the NHS – including the urgent need to replace dangerous concrete planks – in the Budget.”

What’s clear is that all of the think tanks and employers’ bodies know the scale and urgency of the cash and capital crisis after 13 years of inadequate funding: but when push comes to shove it will be campaigners and the health unions that will have to wage the fight at local and national level to prevent another round of cuts and force ministers into investing enough to restore and expand our NHS.




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