Health Organisations React to Autumn Budget and Spending Review 2021

Dawn O'Shea

October 28, 2021

Editor's note, 28 October 2021: This article was updated with additional comment from the BMA.

There has been a mixed response from healthcare organisations to the 2021 Autumn Budget and Spending Review (SR21). While there has been a general welcoming of the additional funding for the NHS, some have criticised the government for failing to seize the opportunity to address crippling workforce shortages in the health sector.

The budget includes a commitment to increase the NHS resource budget to over £160 billion by 2024-25, with investment projected to grow by 3.8 per cent each year on average in real terms over the SR21 period.

In a move to streamline the provision of care, £2.3 billion is being provided to create at least 100 community diagnostic centres across England to permanently increase diagnostic capacity. A further £2.1 billion has been allocated to supporting the use of digital technology which, Chancellor Rishi Sunak said, will free up valuable NHS staff time and ensuring the best care for patients wherever they are.

As previously announced, the government plans to spend more than £8 billion over the review period (up to 2024-25) for a major catch up programme that will help the NHS to provide elective care that was delayed by the pandemic. The aim is to deliver around 30 per cent more elective activity by 2024-25 than before the pandemic. This will be supported by £5.9 billion capital investment to tackle the backlog of non-emergency procedures and modernise digital technology.

In the region of £9.6 billion has been allocated to fund COVID-19 related health spending, so that the NHS can continue to respond to and mitigate the impacts of the virus.

Mr Sunak also confirmed that £4.2 billion will be spent over the next three years on 40 new hospitals and over 70 hospital upgrades.

A Missed Opportunity

But several organisations have spoken out about the missed opportunity to address the greatest challenge affecting the NHS - workforce shortages.

Dr Andrew Goddard, president of the Royal College of Physicians, welcomed the news that the NHS will receive an additional £5.9 billion in capital funding, including much needed investment in diagnostic facilities and IT capacity, which will support efforts to tackle the backlog of care.

“But it’s no good having new equipment if there aren’t enough skilled staff to make use of it,” he said. “The size of the NHS workforce is one of the biggest limiting factors on our ability to get services back on track. To make the most of this new funding we need enough staff to conduct tests and deliver treatment, which is why we’re disappointed that the government didn’t take the opportunity to significantly increase the number of medical school places.

“It is vital that we build a sustainable NHS workforce so that we have the doctors, nurses, physician associates and other clinicians we need to meet future patient demand.”

The NHS Providers organisation, which represents NHS hospital, mental health, community and ambulance services providers, was similarly disappointed. Deputy chief executive of the organisation, Saffron Cordery said it’s members are frustrated that there is no confirmed multi-year increase in Health Education England’s NHS education and training budget.

“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.”

She said: “The NHS faces an enormous challenge to maintain quality of care given the longest and deepest financial squeeze in NHS history between 2010 and 2019, the NHS’ resulting inability to grow its capacity to meet growing demand, persistent workforce shortages and the fragility of social care.”

The Royal College of Radiologists (RCR) welcomed the announcement that funding from the new Health and Social Care Levy will go directly to improving frontline capacity and supporting innovation, and that more than £4 billion will go towards boosting diagnostics, infrastructure and IT, but said this, on its own, is not enough.

RCR President Dr Jeanette Dickson said: “The new scanners, community diagnostic centres and streamlined care pathways promised will be critical in helping to tackle the COVID care backlog and record waiting lists, enabling NHS services to diagnose and treat patients faster, while safeguarding emergency care resources.

“But new machines and delivery models will only take us so far. It is hugely ambitious to expect exhausted healthcare teams to hit and sustain recovery capacity targets purely by deploying new equipment and efficiencies. We all know the NHS needs more staff, and it is vital that more is shared about how the funding detailed [yesterday] will work towards bridging the staffing gap.

“We have seen very welcome rises in training places in imaging services - which are so fundamental to patient diagnoses and treatment - and cancer care. But recent boosts do not ensure we can continue at the current inadequate level of service in the future. Without sustained workforce investment in our specialties, by 2030 the NHS is set to be short of 6,000 radiologists and 700 clinical oncologists.

“We are pleased at the Government’s clear and repeated commitment to upgrading and streamlining the NHS, and await more information about how and where capital expenditure will be targeted. The RCR will continue to campaign for the additional staffing that is desperately needed in our specialties, and we look forward to working with NHS leaders and medical training colleagues on the issue as the realities of the Budget and Spending Review funding emerge over coming months.”

BMA Pensions Committee Chair, Dr Vishal Sharma, said: "It’s so frustrating to see the Chancellor missing an important opportunity to help keep thousands of doctors working in the NHS. He absolutely should have reformed the long-standing issues with pension taxation to avoid affected doctors reducing their working hours or retiring altogether. 

"It’s all very well announcing almost £6 billion worth of capital investment for the NHS, but without plans to increase staffing or, crucially, to ensure that we retain the doctors we have, the impact on the huge backlog of patients needing care will be minimal.  

"Pension tax has a major impact on doctors’ ability to care for their patients. It can lead to the perverse outcome that many doctors may face financial detriment if they undertake additional work or work for longer in the NHS. As a result, doctors have been left with little alternative but to reduce their working hours at a time when waiting lists are at their highest for many years and the NHS is already facing a huge staffing crisis."  

Research and Development

As part of SR21, the government announced that it is increasing public R&D investment to “record levels” - £20 billion by 2024-25. This is an increase of around a quarter in real terms and represents progress towards achieving the target of investing 2.4 per cent of GDP in R&D in 2027. 

The Chancellor also committed to funding full association to Horizon Europe, which has been a major concern for researchers in the post-Brexit era. In the event that the UK is unable to join Horizon, the allocated funding will be redirected to UK government R&D programmes, including those to support new international partnerships

In addition, £800 million will be allocated over the next 4-5 years to establish the new Advanced Research and Invention Agency (ARIA), which will carry out “high-risk, high-reward research to support ground-breaking discoveries across the UK”.

New scale-up, high potential individual and global business mobility visas have been announced, which will aim to attract highly skilled people and support inward investment. The government is also creating a Global Talent Network - launching in the Bay Area and Boston in the US, and Bengaluru in India - to find and bring talented people to the UK to work in key science and technology sectors. 

Prof Dame Anne Johnson, President of the Academy of Medical Sciences, said SR21 “at long-last sets out a three-year rising budget for R&D that the research sector has been crying out for and I am glad that the Chancellor has listened and taken action. Increasing annual investment to £20 billion by 2024/25, whilst it involves pushing the government’s own £22 billion target back two years to 2026/27, represents a very significant uplift to the overall R&D budget.

“I am particularly pleased to see increases in investment in health research through the National Institute of Health Research, a multi-year settlement for UK Research and Innovation and the National Academies, and a renewed ambition to make the UK’s visa system more attractive to overseas talent.”

She said important questions remain, particularly in terms of the UK’s ability to finally secure full association to Horizon Europe. Overall, she said, the settlement announced as part of SR21 “represents a real step forward, showing that this government is starting to put its money where its mouth is when it comes to being a science superpower”.

Action on Alcohol

The government has taken advantage of regulatory and legislative flexibilities afforded by Brexit to change the alcohol duty system. Drinks will now be taxed in proportion to their alcohol content, and a new tax relief is being introduced, which will see duty rates on draft beer and cider being cut by 5 per cent.

The move has been met with strong criticism from organisations working to reduce the harm caused by alcohol. The Alcohol Health Alliance UK (AHA) represents more than 60 such organisations, which include medical royal colleges, charities and treatment providers.

Professor Sir Ian Gilmore, AHA Chair welcomed the announcement of the government’s plans to reform the alcohol duty structures. The Alliance has long campaigned for changes to the way alcohol is taxed to ensure that the strongest, most harmful drinks always cost the most as they cause the most damage to society.

“However,” Professor Gilmore said, “the decision to once again freeze alcohol duty is totally misguided.”

“We are already at crisis point when it comes to alcohol harm. Deaths caused by alcohol reached record highs in 2020 and making alcohol even cheaper will only deepen the health inequalities that this government had promised to address.

“For years, alcohol duty has been cut or frozen in the Budget. This has cost the Treasury £1.8 billion annually - money that is desperately needed elsewhere to aid the COVID-19 recovery. Revenue generated from alcohol tax doesn’t even begin to cover the costs to society of alcohol harm,” he said.

"We need the government to make the most of the opportunity that has been created with the new duty system to introduce much more ambitious measures to decrease the affordability of alcohol and reduce its unacceptable harm to our communities."

This article originally appeared on Univadis, part of the Medscape Professional Network.

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