Autumn Budget 2021: a mixed bag

Budgets and spending reviews are rarely all good or all bad - and this one is definitely a mixed bag, with a vital role for members to work with the CSP to campaign on and influence what has been announced, says Rob Yeldham, director of strategy, policy and engagement.

by Rob Yeldham

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Budgets and spending reviews are rarely all good or all bad. Chancellors always try to do the illusionist’s trick of attracting attention to one element or another to divert attention from the less palatable decisions. This year the Chancellor tried to pull off the diversion in advance by selectively revealing elements of the Budget to the media. 

Health and care 

The Budget included extra health spending. As this was one of the areas pre-released, the CSP has already commented. But the detail yesterday revealed two major areas of concern: 

  • If it is enough to meet to meet Covid legacy and transformation needs
  • Is it directed to the right places. 

The respected independent Kings’ Fund has pointed to the lack of investment in addressing the NHS workforce crisis. Another think-tank, the Nuffield Trust, said there is insufficient funding to meet social care demands. The Health Foundation also pointed to insufficient money for social care and workforce but also highlighted the lack of investment in public health. So on balance the consensus on the level of funding seems to be a good effort but could do better!
 
The CSP has long argued that more money needs to go hand-in-hand with change in the NHS. Where the health funding is directed is worrying. The focus is on acute services and one-off capital investment in buildings, diagnostic kit and IT, all of which do need addressing. What is lacking is any shift to investment in prevention, community services, rehabilitation or social care. To deliver the Long Term Plan and improve care for patients a shift of resource is needed. This spending review does not deliver that.
 
The Chancellor’s NHS funding announcements only relate to England. Under the Barnett formula the governments in Scotland and Wales and administration in Northern Ireland will receive additional grants as result of the extra spending in England. How this is allocated in each country will be up to the politicians locally. 

AHPs

On a more positive note, unusually there were specific commitments to invest in allied health professionals. There is a commitment to ensure the pipeline of AHPs, although there are not specifics on how or on numbers. There is a commitment to recruit more AHPs into primary care. This could include FCPs and other physios or physio support workers delivering care for GPs. However the specific FCP numbers commitment in the Long Term Plan is not referenced which may be of concern. There is also some additional funding for AHP related research.

Prevention

Tax can play an important part in addressing unhealthy behaviours. Choices on taxing polluting products and services can impact on air quality and other environmental factors which directly impact on health. Here the Chancellor was inconsistent; increasing tobacco duty by more than inflation but cutting duty on some alcoholic drinks and domestic flights and freezing fuel duty. 

Member incomes

Small business organisations have largely been critical of the Budget for not offering any support to small businesses recovering from the impact of the pandemic. For self-employed and small business owning physios there will be concern about the predicted inflation rate. Rising costs will mean many need to increase their fees. Whilst this may be possible for self-paying patients, insurers may resist fee rises. There are unfair legal barriers to self-employed members combining to challenge fee rates

The increases to national insurance and freezing of income tax thresholds will take more money out of most members' pockets, in part to pay for more health spending. For most of those on low incomes the loss of £20 a week universal credit will not be made up for from the changes to tapering announced yesterday.
 
Real terms incomes have been falling for many years. So the lifting of the public sector pay freeze will be welcome to CSP members working in the public sector, especially those outside the NHS. It shows that the lobbying by the TUC, which the CSP has been directly involved in, has had some impact. 
 
Whilst English NHS staff received a pay award last year, its low value was undoubtedly influenced by wider pay policy. So this is also important for NHS staff. The big unknowns are what offer the government might make next year and whether pay increases will be fully funded or have to be funded by service cuts.

CSP action

From a CSP perspective the Budget was definitely a mixed bag, but what are we doing about the areas we think are a problem?
 
Recognition of the need to address the AHP workforce is a step forward but the lack of focus on investing in rehabilitation is of great concern.  We will be lobbying to secure clear political commitments to invest in reformed rehab and the physio workforce.
 
The prospect of a more realistic approach to public sector pay is welcome, but it isn’t a guarantee that real terms pay cuts will be addressed. So ongoing campaigning is needed across the health unions to achieve fair pay.
 
For our self-employed members the CSP is working with several other health unions to seek legal advice to see if there is any legal way for us to represent small businesses with health insurers.
 
In all these areas we will need members to help us campaign and influence.

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