Shock at Budget’s total failure on health and care Patients looked to the Chancellor today to make a big offer on health and care. With the COVID-19 crisis entering its final phase – all being well – attention is turning to how the nation will rebuild, including its health and care services. Astonishingly, what the Chancellor actually offered was less than zero: at this critical moment, health and care spending will be cut by £30 billion in total, £9 billion coming from NHS England’s budget. Cuts in capital expenditure of £3.6 billion are coming on top of that. The Chancellor might wish to argue that the lower spending totals for 2021-22 reflect inflated spending in 2020-21 to cope with COVID-19, which might be true: but the costs of COVID-19 and the recovery from it will not drop so dramatically in a single year, leaving the health and care system facing a financial black hole at the worst possible moment. What was needed? In our submission to the Treasury ahead of the Budget, we made clear that major investment would be needed both to cope with the aftermath of COVID-19 on multiple fronts, and to tackle the structural problems that were already apparent before it. New funding would be needed: To cover added costs from COVID itself To pay for clearing the backlog of planned treatment and restoring normal services To bring baseline NHS funding, excluding COVID costs, back in line with historical trend growth To pay for service transformation under the Long Term Plan To fund the Government’s stated plans for hospital building To reverse cuts in public health budgets To top up social care budgets as a stop-gap while the new settlement is devised and implemented. Apart from a claim of £3 billion ‘extra’ to help with COVID recovery, today’s Budget doesn’t do any of those things – and that supposedly extra money is more than offset by the overall cuts. The lack of any sort of vision for the health and wellbeing of the nation after COVID-19 is astonishing. There were some other COVID-related measures in today’s announcements: the furlough scheme and the increase in Universal Credit will both be maintained until further into this year, for instance. But overall, the Budget appears not to grasp the scale of the crisis, and the scale of the response required. In our submission, we outlined likely knock-on effects from social and economic dislocation arising from the pandemic, and argued that a strategic, co-ordinated approach to health and wellbeing across all areas of government policy, with a strong focus on reducing health inequalities, is more vital than ever for this reason. But the Chancellor appears not to have understood this at all. The outlook Patients therefore appear set for another bleak year or more ahead. There will probably have to be some emergency cash injection into the NHS at some point, given how plainly inadequate today’s settlement is. But the health and care system as a whole will not be able to plan with confidence to reduce the backlog, bring down waiting lists and deal with the health needs that will arise over the longer term from both the pandemic itself and the successive lockdowns that have been essential in controlling infection levels, but come at a cost to people’s wellbeing. For all that the vaccine roll-out might give us overall reason to feel optimistic, and showcase both what the NHS can achieve and the strength of the UK’s medical research base, today’s failures by the Chancellor store up problems that will be a black cloud on the horizon in the coming years. John KellHead of Policy Photo of the Chancellor by HM Treasury on Flickr, under Creative Commons licence BY-NC-ND 2.0.