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Reflections on the 2016 Budget - RCP president’s blog

RCP president Jane Dacre comments on the government’s budget

It is strongly encouraging that the government has made huge strides on the public health agenda. I was delighted to see the Chancellor’s announcement of a levy on producers of soft drinks that contain added sugar. Rising levels of obesity and associated health harms are placing unprecedented demands on NHS resources and having huge implications for the health of the nation. The estimated cost of obesity to the UK economy is approximately £27bn[1].

Although this levy is welcome, no single policy intervention alone will reduce the prevalence of obesity. We need a strong package of measures and concerted action across all government departments to turn the tide on obesity. I hope that the government will be able to build upon the new levy in the upcoming childhood obesity strategy and introduce a range of complementary measures as outlined by the Obesity Health Alliance.

In addition to strides made on reducing sugar consumption, the planned increases in tobacco duty of 2% above the rate of inflation for manufactured cigarettes and 5% for hand-rolled tobacco will provide a significant boost in the campaign to reduce smoking. However, cuts to local authorities’ public health budgets are having a damaging impact on services that help people to stop smoking[2]. We hope that the government’s tobacco control strategy, due to be published this summer will set out ways to support these vital services.

Although measures to promote public health will reduce the number of people needing care, the NHS still faces a growing financial crisis. Large numbers of hospitals are currently in deficit – the 151 foundation trusts regulated by NHS Improvement expect to end this financial year £2.5bn in the red[3].

This funding crisis is further exacerbated by an increasing problem in recruiting enough doctors. The latest census of consultant physicians and higher specialty trainees conducted by the RCP and our sister colleges in Scotland[4], shows that four in 10 vacant consultant posts advertised last year went unfilled. The most common reason is due to the lack of suitable candidates. A further one in five consultants reported gaps in their junior doctor rotas. The shortage of doctors in the UK is well documented and was acknowledged by Professor Sir Bruce Keogh during the RCP’s annual conference, Medicine 2016.

Another key issue highlighted during Medicine 2016 was morale in the medical profession. A shortage of doctors will only exacerbate how over-worked and undervalued many doctors feel at present. In addition to the implications this will have for patient care, if we have neither enough trainees nor consultants to run the service now, how are we going to implement a safe seven-day service by the end of this parliament?

Increased funding for social care is crucial to relieving some of these pressures on the NHS. It is naive to think that the NHS will be able to meet the wider care needs of patients and growing financial pressures without adequate funding for social care. This is an issue which I highlighted in a recent letter to George Osborne before the budget. We are already seeing the impact of an underfunded social care system in the additional pressures being experienced in our hospitals. Across the country patients fit for discharge are waiting to leave hospital, in many cases because social care support is unavailable. Increasing the level of social care funding will ultimately alleviate pressures on all sectors of the NHS, and would likely save money as a result.

Despite the many pressures facing the NHS, I left Medicine 2016 feeling positive about the future of the health service and about the willingness of the medical profession to work together to solve these problems. So my message to George Osborne is: give us the investment we need to shore up our debt-riddled trusts to prevent cuts; invest in social care and prevention to relieve pressures on the NHS; and invest in more doctors and other healthcare staff.

[1] ‘The Economic burden of Obesity’, National Obesity Observatory, PHE, October 2010.

[2] Results of a survey of tobacco control leads in local authorities in England. Action on Smoking and Health.

[3] Sustainability and financial performance of acute hospital trusts. The Committee of Public Accounts. 2016

[4] These are the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow