The Week 17 March 2023

The Spring Budget has understandably dominated the newsfeed this week, and this time the market turmoil was unrelated. See here for Reform’s analysis of the good and the bad of the latest fiscal event. Onto other news…

Yesterday, the Department of Health and Social Care announced that a long-awaited pay deal to end industrial action by NHS workers had been struck. Nurses, paramedics and other non-medical staff will receive sizeable one-off bonus payments this year and a 5% pay uplift next year, which will be higher than projected inflation (4.1%) and private sector pay (4.5%). At a time where all public service budgets are under pressure, this looks like a fair and pragmatic deal.

But a big question mark remains over where the money is going to come from. It isn’t clear that the Treasury will provide the additional funding, leaving the Department and NHS to find savings in their existing budgets to increase pay. The Health Secretary has promised that any efficiencies “will not come from patient-facing aspects” and may instead be found in areas such as “administrative savings”. But, as Reform has argued, using management and administration budgets to pay for frontline staff in fact makes providing care more difficult.

More worryingly, as reported in the HSJ this morning, the Department may look to find savings in social care budgets. Putting aside the fact that England’s creaking care system is in desperate need of greater investment, this too would have a damaging effect on the NHS which relies on its social care partners to prevent hospitalisation and move patients back home at the end of their stay. Yet another example of false economies driving spending decisions.

Which brings us on to this timely briefing from Nuffield Trust, published on Monday, looking at the state of publicly funded social care. The capacity of the system to provide quality care continues to diminish. Nothing new here and the same culprits are responsible: lack of sufficient funding, an increase in complex health needs and, of course, severe workforce recruitment and retention issues. With vacancies continuing to soar, “the workforce has shrunk for the first time since records began”.

There has been an increase in unpaid carers providing more intense care. Considering the budget reference this week to “1.7 million people in the UK who report looking after their family or home as their main reason for inactivity”, and that one of the “four pillars” for economic growth is employment, it is baffling that any consideration would be given to directing funding away from this area.

The Nuffield briefing also provides insight into the demand for care. Analysis of requests for care support show that those made by people aged 65 and over to local authorities has increased by 4.6%. But, accounting for population ageing, this actually “represents a 3.1% decrease in rate of requests”. This challenges the usual claim that increased demand is due to an ageing population. This is partly because “a person aged 80 today is less likely to need care than a person aged 80 a decade ago”. Good news! However, it could also be explained by pandemic-related behaviour change (people staying at home more and relying more on unpaid care).