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Long-term funding is what health and social care needs

Ahead of the Chancellor’s Spending Review, RCP president Professor Andrew Goddard reflects on what health and social care needs both now and beyond the pandemic.

In the early stages of the government’s response to the pandemic, the Chancellor said the NHS would get “whatever it needs” to deal with COVID-19. This week’s one year Spending Review is an important opportunity to deliver on that pledge, but for real long-term improvements we need long-term funding commitments.

Tomorrow we expect to see more investment in social care and public health, alongside the trailed £2.5bn for the NHS and £500m for mental health services. We will also welcome further detail on how the government will meet its manifesto pledge to upgrade 20 hospitals.

But as we enter a new year, we hope a multi-year spending review is on the cards. Without long-term investment we will not see long-term improvements. If this year has shown us anything, it is that we need to accept some short-term pain - in terms of increased spending - for long-term gain – being prepared to weather public health crises.

Because as we said in our recent letter to the prime minister on behalf of the Inequalities in Health Alliance, the pandemic has reminded us of the importance of high levels of general good health. We have seen all too clearly that by allowing more and more children to become obese in the past we increased their risk of dying from COVID-19 in the present. We need to be prepared for future pandemics, and make sure all public policy is focused on making sure every child has the best chance of good health throughout their life.

The pandemic has placed enormous pressure on the delivery of services this year.  In June almost half of medical specialties expected to be working at lower than pre-COVID activity levels for at least a year. The second COVID-19 wave this autumn has  exacerbated these problems – in our last member survey, 82% of members reported delays in endoscopy tests for outpatients.

Targeted funding to deal with NHS backlogs and other existing pressures would be very welcome, but these pressures are ultimately the result of long-term workforce shortages. Our most recent consultant census showed that 43% of advertised consultant posts were unfilled – almost the exact same proportion of unfilled consultant posts the year before. There is no quick fix to this problem. It will require long-term funding commitments, including for a significant expansion of medical school places. The most effective way to reduce NHS backlogs and ease pressure is to increase the workforce that is available to treat patients.

News of a vaccine has highlighted the critical role of clinical research in improving patient care. Without proper long-term investment in the medical workforce, doctors will have to spend almost all their time providing direct clinical care. That will mean they are unable to engage in patient-facing research, or other vital work such as quality improvement.  

Short-term funding for the NHS and social care is needed and is welcome, but  the COVID-19 pandemic has exposed and exacerbated problems that we’ve been aware of for years. It is impossible to ignore that what our health and social care system really needs is long-term investment.