With the current occupant of Number 11 Downing Street set to unveil a ‘fiscal event’ at the end of this month is there much hope that the already battered finances of the NHS could emerge relatively unscathed?

As a former chair of the Commons health and social care committee, praised for pushing the government on NHS workforce planning issues, chancellor Jeremy Hunt should be sensitive to the impact of any new ‘efficiency savings’ imposed on the health service. 

But Hunt assumed his latest role on the assumption that he’s prepared to take some “very difficult decisions” to lower government debt to below September’s record figure of £20bn. That hints at a return to the last decade’s austerity cuts to social care and the NHS which – according to research from York University – were linked to more than 57,000 extra deaths between 2010 and 2014. More recent statistics, from Glasgow University, suggest a much higher figure (almost 335,000 additional deaths between 2012 and 2019) is directly attributable to those Tory spending decisions.

The chancellor’s words have understandably triggered widespread alarm across the health sector, with leading figures such as NHS Confederation chief executive Matthew Taylor describing the prospect of further cuts as “incredibly grim”.

What might be on the cards

So what do we know so far about the approach Hunt might take later this week? 

Given the current nervousness of the money markets, it’s unlikely any details will be leaked before the ‘mini Budget’ is formally announced, but it’s widely accepted that he won’t reverse his predecessor Kwasi Kwarteng’s decision to scrap the £7bn health and social care levy which was destined to boost the NHS’ coffers.

One leading economist has suggested that the government will need to impose £30-40bn of spending cuts or tax rises, while another put the figure higher, at £50bn. The Telegraph has claimed that Hunt is considering up to £20bn of tax rises to fill the hole in the nation’s finances, and contributors to last week’s hsj podcast on the ‘mini Budget’ said that Hunt recognised the NHS clearly needs more cash and that people therefore needed to pay for that – with tax rises the most obvious option. 

The HSJ team noted that the chancellor had recently rubbished the social insurance model, long-favoured by Tufton Street thinktanks, as a way of financing a public health service in the UK. That observation, though, jars with a call – promoted in a book co-written by the then-shadow minister Hunt back in 2005 – to replace the NHS with a system under which patients would pay into personal health accounts, allowing them to shop around for care from private as well as public providers.

They also suggested that Hunt could be set to drop the idea of a cap on social care costs completely, and may also float the reintroduction of PFI schemes to help deliver the long-promised 40 ‘new’ hospitals. Unsurprisingly, the HSJ podcast predicted that the chancellor would probably seek to inflict 12 months of financial pain in the short term, in order to facilitate 12 months of politically advantageous investment in public services in the run-up to the 2024 general election.

Hunt’s track record

But does Hunt’s record in his earlier role of health secretary, from 2012-18, offer any hints that he’ll do right by the NHS financially, rather than just cut it to the bone?

Not really. Despite his recent stance on workforce planning while chairing the Commons health and care select committee, Hunt has previously been criticised for failing to take sufficient action on recruitment issues in the NHS while he was in charge of it. His tenure in the post saw the total number of GPs go down, a poor reflection on his pledge in 2015 to hire 5,000 more within five years. 

In an interview with the BMJ 18 months ago, Hunt acknowledged that his inaction on recruitment affected the NHS’ ability to respond to the pandemic, and went on to say, “We’ve really been on the back foot from the start on test and trace, and in some ways it dates back to when I was health secretary.”

And in 2016 he was called out by his predecessors on the Commons health and care committee for breaking his pledges on NHS funding and misleading the public about health service reforms. The committee had found that a promised top-up of £8.4bn for the NHS was actually closer to £4.5bn.

According to an  analysis from OpenDemocracy, behind Hunt’s ‘nice guy’ disposition lurks a very different persona, whose story as health secretary is “one of missed targets, lengthening waits, crumbling hospitals, missed opportunities, false solutions, funding boosts that vanished under scrutiny, and blaming everyone but himself”.

Over the period Hunt was in charge at the DHSC, the performance figure for four-hour maximum waits in A&E dropped by 10 per cent, more than 8,000 hospital beds were lost, and access to treatments including hernia, hip and knee operations were delayed, restricted or in some cases scrapped, nudging some hospitals to instead offer ‘self pay’ options to private patients. 

During Hunt’s watch funding increases dropped to around one per cent (from an average of six per cent pre-2010), while extra funding sometimes arrived in the form of loans, adding to individual hospitals’ debt burden. Hospitals also started to receive significantly less funding per procedure – payments which once made up 75 per cent of their income.

An apparent predisposition in favour of privatisation soon emerged during Hunt’s time in office too (Virgin Care, Circle and Carillion all seemed to do well on his watch, and he was instrumental in bolstering those elements of the 2012 Health and Social Care Act which required commissioners to put contracts out to tender) alongside a tendency to dodge public scrutiny – prompting frustrated hospital campaigners to launch a “Hunt the Hunt” campaign to get him to engage in public debate. The Hunt-era DHSC was also reluctant to respond to FoI requests and parliamentary questions, and Hunt was personally pulled up by the UK Statistics Authority for making misleading claims about NHS funding. 

Can the NHS withstand more austerity?

The NHS will surely struggle to survive more cuts. Just consider the following news items, all appearing over the last month, and all relating to historic funding issues:

– The number of patients waiting for hospital treatment in England has topped seven million for the first time… just 56.9 per cent of patients attending major A&Es are seen within four hours (a record low)… and the number waiting more than a year for treatment rose to almost 390,000 (up almost 10,000 on the previous month)  

– The cost of clearing the backlog of repairs to NHS hospitals and equipment has exceeded £10bn for the first time (up 11 per cent year on year)… about £1.8bn of this backlog are now considered “high risk” repairs… roofs of 30 hospital buildings at 18 NHS trusts are in danger of collapsing

  British Dental Association head Martin Woodrow has told Hunt, “In blunt terms, NHS dentistry is approaching the end of the road. There is simply no more fat to trim, short of denying access to an even greater proportion of the population. It would take an extra £880m a year simply to restore levels of resource to those we saw in 2010”… the number of ‘dental deserts’ is growing across the UK, according to the Local Government Association… no local authority area in the country had more than one dentist providing NHS treatment per 1,000 patients… and one report suggests there are no NHS dentists left in the whole of Suffolk

Analysis backs investment

The case for investing in the NHS was eloquently presented by the NHS Confederation earlier this month, in research commissioned from independent consultancy Carnall Farrar. Their analysis showed that investing in the primary care workforce, for example, shows links to reduced A&E attendances and non-elective admissions, and so leads to improved workforce participation. The consultancy was able to quantify the benefits of treating the NHS as a sensible investment rather than as a cost: for each £1 spent per head on the NHS, Carnall Farrar identified a corresponding return on investment of £4.

One can only hope Jeremy Hunt gets a chance to read this excellent research, and acts on its recommendations, before delivering his fiscal event.

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