Home » News » Reflections on the spending review

Reflections on the spending review

Following the Chancellor’s Spending Review, RCP president Professor Andrew Goddard reflects on the sticking plaster for social care, the absence of public health, and the need to tackle health inequality at home and abroad.

As I said in my article on Tuesday, there is only so much that can be achieved in a year. Long-term improvements in health and social care require long-term planning  and this is all but impossible if it is not underpinned by long-term funding. The RCP hoped that the Chancellor would reflect on the health and social care pressures that have been exposed and exacerbated by the pandemic, and provide targeted funding appropriately.

We had expected to see investment in social care and public health, alongside money for the NHS to balance delivering COVID and non-COVID care. While we welcome the £2.5bn for the latter, the settlement for social care is inadequate. Most worryingly, there was nothing for public health.

The £2.5bn will help us get through the next year. But next autumn we really need to hear about long-term investment to fix the root cause of the pressure we’re under: an inadequately sized workforce. The most effective way to reduce NHS backlogs and ease pressure is to increase the number of clinicians available to treat patients. That requires long-term commitments, including for a significant expansion of medical school places.

Some of the pressure on hospitals is also down  to the under-resourcing of social care. It increases the number of people who need to be in hospital and delays them leaving. The funding announced is merely a sticking plaster, far from what is needed. So we look forward to the proposals that government has today promised to bring forward next year, and reiterate that it is vital the prime minister delivers on his commitment to fix social care.

The pandemic has reminded us of the importance of high levels of general good health, which is why it is so disappointing that the government decided not to increase public health funding to stop people becoming ill or unhealthy in the first place. COVID-19 has demonstrated how health inequalities can have an impact in just a matter of weeks – and how we are paying the price now for public health policy decisions taken in the past. For example, by allowing more and more children to become obese in the past, we have increased their risk of dying from COVID-19 as adults in the present.

It is indisputable that the rates of infection are worst in areas where people are poorer. There is a clear moral case for reducing health inequality, as well as recognition that a healthier population would take pressure off the NHS. But it is also something the public cares about: 81% agree there should be a UK government strategy to reduce health inequality. Investing in public health is a vital part of this, as is the national strategy we are calling for - with over 130 organisations - as the Inequalities in Health Alliance.

Finally, ‘pandemic’ has become a familiar part of our vocabulary this year – but we mustn’t forget that ‘pan’ means ‘everywhere’. While COVID-19 cases first emerged in December 2019, it was not declared a pandemic by WHO until March 2020. In a globalised world, the health of all countries is inextricably linked. COVID-19 should serve as a reminder that the benefits of investing in development across the world has benefits beyond that country – something for us all to reflect upon as the foreign aid budget is cut from 0.7% to 0.5%.

This Spending Review should have been about laying the ground as far as possible for long-term, multi-year investment in 2021. The Chancellor said the economic emergency has only just begun; the health emergency continues – and won’t end with the end of the pandemic.