What will austerity 2.0 mean for the NHS?

When times are hard, it is always those at the bottom of the pile who bear the brunt, writes Ian Hamilton

Starving the NHS of funds will accelerate inequality further (EPA)

The chancellor and prime minister are committed to the NHS budget agreed in last year’s spending review, albeit with the caveat that there must be yet another drive for efficiency.

The spending review confirmed the total NHS budget would rise from £151bn in 2021/22 to £166bn in two years’ time. If the government is to keep this commitment, then something must give. They have already reversed the planned rise in national insurance that was originally meant to cover this rise in NHS funding. As tax rises appear to be an ideological anathema to Liz Truss, that leaves only borrowing, but we’ve all witnessed how expensive that is for the UK government.

So where will they find the money to keep this political promise? We are beginning to get some clues in their not-so-subtle talk of finding efficiencies and economies in all government departments. The most recent target being mentioned is the spend on universal credit and other benefits. An easy push for a cabinet wedded to the mantra that “work is the best route out of poverty”, which translates as the need for the lazy to get working and not rely on the state for support.

But even bearing down on this budget will not yield the planned rise in spending for the NHS. I suspect there is another “soft” target that they think would be popular with their core vote. For decades, the NHS has incrementally outsourced much of its work to the third sector. Services that provide support for people with a range of physical and psychological problems, from learning difficulties to dependency on drugs, are now provided by these charities. They don’t deliver the “nice-to-have” add-ons – they are providers of essential day-to-day care.

Responsibility for these services has gradually been handed over to local authorities. Some money will be ring-fenced, but most will not. Either way, it won’t matter as local authorities continue to be squeezed like never before, forcing them to make impossible decisions based on a false hierarchy of needs. Paralleling their beneficiaries, it is these budgets that are the most vulnerable as they have somehow come to be thought of as “discretionary” spending by politicians.

Reducing this tension between social care and health prompted the amalgamation of these departments into one, the Department of Health and Social Care. But this department still hasn’t published a workforce plan. Little wonder it is so coy when the Nuffield Trust revealed the NHS has lost one in nine of its nurses over the last year, cancelling out the number of new entrants. The promise to recruit 50,000 more nurses looks in need of intensive care.

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When times are hard, it is always those at the bottom of the pile who bear the brunt – and so it will be with austerity 2.0. Picking on this group is a cynical political tactic because they have no advocacy and little in the way of public empathy.

We are all complicit in this, as evidenced by repeated polling about the NHS and how it should be funded. On the one hand, we want the NHS to receive more money, but on the other, we do not want to be the ones paying for it. There could be leeway in this schism, given how reckless the government has been with the money we have already given them and the additional money our grandchildren will owe.

Since its inception, the NHS has contributed significantly to reducing inequality, although the gap between the haves and have nots has grown in recent years. Starving the NHS of funds will accelerate inequality further.

The prime minister must publicly acknowledge that the original goal of the NHS, to provide care without cost at the point of need, is no longer true. No one else believes this, and we all have personal stories to prove it. Liz Truss will no doubt continue to talk of finding NHS “efficiencies” that could save millions – despite the NHS skeleton having no fat left to trim.