Spending review: some welcome news for the NHS – but where’s the workforce plan? 

Wednesday’s spending review saw the chancellor, Rishi Sunak, dig deep into his pockets to pull out £20bn in research and development (R&D) funding – including an increase of Innovate UK’s budget to £1bn – as well as nearly £6bn in capital investment for the NHS. A quarter of that £20bn is to go into health R&D, including initiatives such as Generation Genome, which will sequence the genomes of 100,000 newborns to detect rare diseases. Other money will help the NHS adopt cutting-edge innovations to tackle cancer, obesity and mental health. Not only will this improve diagnosis and treatment, it will boost the economy as it recovers from the impact of Covid-19.  

The NHS funding, split three ways between new diagnostic centres, surgical hubs and IT, is a much-needed step towards clearing the large and growing backlog caused by the pandemic. Currently 5.7m patients in England are waiting for elective procedures, a figure growing by 100,000 a month. Sector experts are questioning if it is enough, or what is most needed.

While many of the announcements are welcome, some questions remain unanswered. The chancellor made little mention of the government’s new net-zero strategy, raising the concern that irresponsible innovation could hurt rather than help the climate. The R&D funding is going to the Department of Health and Social Care (DHSC) rather than to the NHS, so it’s not yet clear how much resource the new Integrated Care Systems (ICSs) will have for innovation. The £2.1bn for NHS IT will help, but that seems designed to improve connectivity and efficiency rather than, for example, the collection and analysis of data to transform care.   

Now we need a workforce plan 

When it comes to the rest of the NHS funding, the fundamental question is:  where does the government plan to find the doctors, nurses, other health professionals and multidisciplinary teams who will staff these new centres and hubs? The NHS is already under-staffed – currently there are 39,000 vacancies for registered nurses in England, a shortfall made worse by a collapse in the number of recruits from Europe. University of Manchester research suggests that the burnout caused by the stresses of working during the pandemic could lead to an exodus of staff.  

The government urgently needs to create a workforce plan to address these issues. Although Sunak restated a commitment to recruit 50,000 new nurses, it’s not clear where they are going to come from. As the chair of the health and social care committee and former health secretary Jeremy Hunt wrote in the Financial Times: “Money without a workforce plan often gets wasted. You can give the NHS billions more a year – but without additional doctors and nurses to provide the extra care, the money can hit the bottom without touching the sides.”  

And while the new diagnostic centres and surgical hubs will go some way to reducing the NHS backlog, other problems remain. Covid hasn’t gone away: in the past week there have been more than 300,000 new confirmed cases, 7,000 patients admitted to hospital and 1,000 deaths. There may be a winter flu epidemic on its way. Millions of people are awaiting their booster jabs, and the government may yet have to implement its Plan B to stave off a further rise in Covid cases. 

Social care left behind 

Sunak also confirmed the health and social care levy which, along with an increase to the rates of dividend tax, will raise about £13bn a year for both health and social care. Initially the bulk of that will go to the NHS: it includes the £5.9bn capital investment, as well as some extra funding for public health measures and workforce training.  Only £5.4bn will go to social care over the next three years. After that, the positions are reversed, with most of the levy being directed towards social care. Given the precarious state of the social care sector, which faces a combination of a rapidly ageing population, workforce shortages, recruitment difficulties and a number of providers teetering on the edge of the collapse, it seems unlikely that the funding will do more than slow down the rate of decline.  

Part of the £5bn going to health R&D includes a pot for the National Institute for Health Research to fund research into health care challenges, including £40 million for social care research. Compared to the money being spent on health innovation, this feels like small change found down the back of the sofa, and it is unclear how (or whether) the outputs will translate into better care delivery.  

We can be cautiously positive that the government is now addressing the underinvestment in health and social care of the past 11 years. The funding announced yesterday will see us conveniently into the next election ­– but whether it will be sustained in the long term, and have an impact felt by FCC’s beneficiaries, remains to be seen.