With hands tied behind its back, Sunak tells NHS to deliver

It was one of the biggest spending increases made by a Chancellor this century – growth of £150 billion in public spending over the next four years and the NHS will swallow almost a third.

In his budget speech to MPs on Wednesday, Rishi Sunak pledged to uplift total health spending by almost £44 billion by 2024-25, an annual increase in real terms of 4.1 per cent.

NHS England’s share of the pot will grow by 3.8 per cent a year in real terms.

Paul Johnson, director of the Institute for Fiscal Studies, said the increased spending was “more in common with Brown and Blair than Osborne and Cameron” reflecting the scale of the rise.

The Chancellor made no mistake that the money for the NHS was designed to trigger a change in fortune for the ailing NHS. Much of it we had heard before: 40 new hospitals, 70 upgrades, 100 new community diagnostic hubs and more operating theatres.

The aim is clear. The NHS must get its backlog of operations and the 5.7 million strong waiting list under control.

Mr Sunak ended his speech with a clear ideological warning: “We’ve taken some corrective action to fund the NHS and get our debt under control.

“But as we look towards the future, I want to say this simple thing to the House and the British people. My goal is to reduce taxes.”

He effectively put NHS England’s chief executive Amanda Pritchard and health secretary Sajid Javid on notice that now they must deliver.

But what he didn’t say was that their hands are tied behind their back.

Annual real-term increases of 3.8 per cent sounds a lot after a decade of austerity but is actually quite close to the average annual spending of 3.7 per cent since the health service was founded in 1948.

And there was scant detail in the budget about any attempt to boost the workforce beyond the arbitrary 50,000 nurses pledge which is almost certainly not enough. Similarly beyond the new health and care levy there was no new funding for social care to help prevent admissions to hospital and get people out faster.

Staffing shortages are hitting the NHS at every level and they can’t be fixed quickly. It needs longer term planning and the Chancellor has made no provision for that, it seems.

NHS Providers, which represents NHS trusts, said the failure to act on workforce was a “missed opportunity”.

Deputy chief executive Saffron Cordery said: “Workforce shortages and the resulting unsustainable workload on existing NHS staff are currently the health service’s biggest problem. They can only be tackled with a robust long-term workforce plan and increased longer term investment in workforce expansion, education and training, none of which are currently in place.”

The health service has shown during the Covid-19 pandemic that it can deliver when given the resources, but the starting point is one of weakness and dilapidation, which ministers have to be honest about.

The structural weaknesses in the health sector – staff shortages, crumbling buildings, a lack of equipment, collapsing social care – risk acting as a major drag on the NHS performance and could well mean the Chancellor’s generosity is simply not enough.