Intended for healthcare professionals


UK government’s autumn statement: no relief for NHS and social care in England

BMJ 2016; 355 doi: (Published 28 November 2016) Cite this as: BMJ 2016;355:i6382
  1. Chris Ham, chief executive
  1. King’s Fund, London, UK
  1. C.Ham{at}

Staff have become shock absorbers in a system lacking resources to meet rising demands

If silence speaks volumes then this year’s autumn statement sent a deafening message to the NHS and its partners in social care. The decision of the chancellor of the exchequer, Philip Hammond, not to heed widespread calls for additional funding, especially for social care, reflects an uncertain outlook for the economy after the June referendum vote to leave the EU. Forecasts for economic growth have been revised downwards, and the timetable for eliminating the deficit in public finances has been extended. In the absence of a willingness to raise taxes, the chancellor was left with little room for manoeuvre.

The government’s inaction came despite speculation that local authorities would be given greater freedom to raise council tax to support a social care system that the usually cautious Care Quality Commission has described as being at a “tipping point.”1 Cuts in social care spending mean that 400 000 fewer older people are receiving publicly funded care than in 2009-10 as councils are forced to ration access to care. These cuts are also having a growing impact on the NHS, with increasing numbers of patients waiting to be discharged from hospital because of lack of support in the community.

Building pressure

Hospitals, already struggling to reduce deficits, are missing out on income from patients whose elective procedures are cancelled because of pressure on staff, theatres, and beds. Waiting times and waiting lists are also lengthening as the gap between increasing demand for care and constrained resources widens. With most acute hospitals in deficit and the NHS facing no growth in real terms in its funding in 2018-19 and 2019-20, the challenges facing the service are endemic and the prospects extremely worrying.

Enter the National Audit Office (NAO), another organisation known for its cautious judgments, which recently warned that the finances of the NHS did not appear sustainable.2 Its report also warned that plans to close the estimated £22bn gap in NHS budgets by 2020-21 had not been fully tested and raised concerns about whether planned savings could be achieved. The NAO concluded that differences between the Department of Health and NHS England on the adequacy of NHS funding “do not help build a confident feel about the future of the NHS.”

These differences centre on whether the NHS has received the additional £8bn funding requested by NHS England to deliver its Five Year Forward View. The health secretary, Jeremy Hunt, has been consistent in maintaining that the government has provided the resources required to implement what he calls “the NHS’s own plan,” a view that seems to be shared by the chancellor and the prime minister. The counter argument is that NHS England is receiving an additional £8bn over the course of the current parliament only because of cuts in other areas of spending controlled by the Department of Health.

When these cuts are factored in the actual increase in the department’s funding is much less.3 Simon Stevens, chief executive of NHS England, has maintained the £8bn figure was predicated on adequate protection of spending on public health and social care, which have both been cut, and has suggested that if additional funds were to become available then the claims of social care should receive priority. Stevens has also argued that per head spending on healthcare in England is set to fall as the population grows and spending is held down.

Although attention has focused on financial and operational pressures in acute hospitals, all areas of the NHS are affected, including general practice, mental health, and community services. Staff working in health and social care have become shock absorbers in a system lacking the resources to meet the demands placed on it. Recent warnings about declining morale from the General Medical Council,4 another institution not given to hyperbole, are an important and timely reminder that staff cannot continue to work in this way indefinitely.

The government’s decision to provide extra funding in response to the crisis in prisons shows what might happen in the NHS and social care. A deepening crisis in social care could result in further and widespread failures among providers of home and residential care, leaving more vulnerable and needy people without access to support. In the NHS, a deepening crisis could entail longer waiting times and a return to the days when patients died on waiting lists or were looked after for hours on trolleys in hospital corridors until beds became available.

Waiting for events of this kind to occur before providing additional funding is an indictment of a political system that seems incapable of finding the resources needed to fund health and social care on a sustainable and predictable basis.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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