Budget and Spending Review 2021 - what it means for health

Published: 28-Oct-2021

£13bn a year for health and social care spending, including investment in digital technology, the transformation of diagnostic services, and the creation of new surgical hubs

Chancellor Rishi Sunak’s Budget speech yesterday committed to raising around £13billion a year for health and social care spending across the UK.

In his Spending Review speech he said the money raised from the proposed new Health and Social Care Levy would go directly to the NHS and social care sector – describing it as the ‘largest health capital budget since 2010’.

It will enable significant funding for the NHS, for the Government’s reforms to social care, public health, and prevention programmes, and investment in training the workforce of the future.

Measures announced include:

  • £2.3billion over the next three years to transform diagnostic services, with at least 100 community diagnostic centres across England – helping millions of patients access earlier diagnostic tests closer to home
  • £2.1billion over the next three years to support innovative use of digital technology so hospitals and other care organisations are as connected and efficient as possible, freeing up valuable NHS staff time and ensuring the best care for patients, wherever they are
  • £1.5billion over the next three years for new surgical hubs, increased bed capacity, and equipment to help elective services recover, including surgeries and other medical procedures

Commenting on the speech, Siva Anandaciva, a health analyst at think tank, The King’s Fund, said the success of the plans to reduce the COVID backlog would need to be underpinned by action to address inequalities.

“The new NHS funding comes with specific targets to increase activity to reduce the backlog.

To help reduce inequalities, the Government should work with the NHS to implement the activity target in a way that allows appropriate local flexibility to address health inequalities

“This is a sensible approach, but there is a significant inequalities issue here, as our analysis shows that those living in the most-deprived areas are nearly twice as likely to wait more than one year for treatment compared to those living in the least-deprived areas.

“To help reduce inequalities, the Government should work with the NHS to implement the activity target in a way that allows appropriate local flexibility to address health inequalities.”

Also concerned about the impact of health inequalities is Dr Jonathan Pearson-Stuttard, head of health analytics at Lane Clark & Peacock (LCP) and chairman of the health inequalities programme board at Northumbria Healthcare NHS Foundation Trust.

He said: “While the budget reports increases in spending on health and social care across the UK, a roadmap is needed from the Government to give clarity on how the additional resources will be spent to ensure this is proportionate to need across regions.

“Additional resources for the elective recovery programme is welcome. However, as the latest data highlights, there are persisting inequalities in waiting list numbers and length of time waited across England.

Even now, NHS leaders do not know how much capital investment they can expect in the coming years, which hampers their ability to plan improvements to NHS buildings and facilities to improve productivity and patient care

“For example, the latest figures show that the number of people waiting 52 weeks or more for orthopaedics now 77 times higher in Norfolk and Waveney than North East Lincolnshire.

“Adjusting for population size shows a 51-fold difference in the orthopaedics waiting list across best and worst performing CCGs.

“Resource allocation that harness data-driven approaches to ensure resources are targeted at the areas with most unmet must be a priority to ensure inequalities do not worsen further as a legacy of the COVID-19 pandemic.”

And Anandaciva warned of a need for greater capital for building maintenance, adding: “Years of constrained capital investment have led to a growing backlog of safety issues with NHS buildings and equipment.

“Even now, NHS leaders do not know how much capital investment they can expect in the coming years, which hampers their ability to plan improvements to NHS buildings and facilities to improve productivity and patient care.

“The Government has yet to deliver on its promise to set out a more-coherent and sustainable multi-year capital investment plan.”

But he did welcome the ‘positive first steps’ towards social care reform.

But, if the NHS can efficiently modernise its data practices in the coming months, it will be able to put a framework in place to become a digitally-native system that can begin addressing the backlog of people waiting for crucial checks, tests and scans, and to help get waiting lists down

He told BBH: “To help manage current pressures, improve access to care, and support the social care workforce, the Government will need to increase core social care funding significantly before reforms start to be introduced in later years.”

The investment in new technology is being particularly welcomed by the healthtech industry, which has seen uptake of innovative solutions increase exponentially since the COVID-19 outbreak.

David Morris, health services leader at PwC, said: “The £2.1billion investment in technology and data is particularly welcome and a clear sign that the benefits of digital transformation are being recognised.

£2.3bn will be spent over the next three years to transform diagnostic services. Image, Okskapet from Pixabay

£2.3bn will be spent over the next three years to transform diagnostic services. Image, Okskapet from Pixabay

“Technology has the power to drive a revolution in health and care outcomes. The pandemic has accelerated the pace of technological change, but much more can be done to deliver truly-innovative transformation.

“There is no appetite to go back to the way things were before the pandemic.

“Patients are embracing new technology and increasingly expect care to be supported by it, but they, along with staff, need to be further empowered and supported to change the way that they engage with and access care.

“This investment must be supported by a large-scale digital skills-building programme that provides all of those involved in the patient journey with the skills required to get real value from new technology.”

And Mike Kiersey, chief technology officer at Boomi, adds: “For decades, the UK public sector has been reliant on a myriad of disconnected, outdated legacy IT systems and it is clear that these current systems cannot meet today’s clinical needs.

“Finally, the sweeping shift towards digital transformation brought on by COVID-19, has led Sunak to set aside £2.1billion to fund the NHS IT modernisation.

The new funding should support digitally-mature trusts to capitalise on existing investments, but also help level-up those where simple tech is needed to make a real and lasting impact

“The NHS runs on the efficiency of information, and on this information being accurate and up-to-date. If, as the report notes, some of the data and technology infrastructures have been unable to keep up with the pace of change, then that is a serious concern, especially in the current circumstances where data needs to be constantly managed, integrated, secure, and accessible to best serve the public.

“While it is promising to see funding being directed to futureproof IT systems, ultimately digital transformation is a delicate process, and one that needs to be carried out over a period of months and years.

“But, if the NHS can efficiently modernise its data practices in the coming months, it will be able to put a framework in place to become a digitally-native system that can begin addressing the backlog of people waiting for crucial checks, tests and scans, and to help get waiting lists down.

“Overall, this will ensure digital systems in hospitals and mental health care settings are as robust, connected, and efficient as possible – freeing up valuable NHS staff time.”

Also key, according to Tom Whicher, chief executive of DrDoctor, is keeping patients informed.

We can make a measurable and significant impact on the backlog very quickly by empowering individuals to access services only when they need to and enabling them to communicate in the way they want

He told us: “With the backlog of elective care and diagnostics building up over the pandemic, patients and service users are rightly concerned about the length of time they have been waiting and are demanding to be kept up to date on where they are in what feels a very-complex system.

“Two thirds of outpatient volume are review appointments, which is why we need to update patients on when they are likely to be seen in the same way they expect to be updated on when an Amazon delivery will come.

“We can make a measurable and significant impact on the backlog very quickly by empowering individuals to access services only when they need to and enabling them to communicate in the way they want.

“The new funding should support digitally-mature trusts to capitalise on existing investments, but also help level-up those where simple tech is needed to make a real and lasting impact.”

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