What to expect after the spending review

Abstract

no bad thing. Some of the saving will come from ending bursaries for student nurses, eventually providing £1.2 billion a year. That, the government argues, will allow the cap on student nurse numbers to be lifted, and there is a logic with the way the rest of higher education is treated in substituting loans for bursaries for student nurses. It remains to be seen, however, what effect the switch in fact has on those choosing to become nurses. Some of the money will come from public health spending, which has already undergone a £200 million reduction since the election. If you believe the public health money is being spent well, then the implications of further cuts are larger demands on the NHS down the line from the very issues—obesity, smoking and alcohol— that the Five Year Forward View said had to be tackled. There is some capital to revenue transfer involved, when, presumably, more capital rather than less will be needed to deliver some of the new models of care—and when it is certainly needed for IT to provide the long promised, way overdue, electronic health record. While the spending review was strong on the rhetoric of integrating health and social care, it was anything but strong on integrating the funding. There is some more money for the Better Care Fund later in the Parliament, but any other additional cash for social care will come only if councils take advantage of their new ability to raise council tax by 2%, ring-fenced for social care. This is yet another example of the last government and this one shovelling difficult national issues—the social fund, council tax benefit and others— down to local government to resolve, often with a cut included. In this case, a form of the inverse care law will come into play—more deprived councils, who are likely to have higher social care costs, will raise least from the levy, if they choose to use it. As all the health think tanks have pointed out, average spending on the NHS over the next five years will be almost identical to that in the last Parliament—around 0.9% a year. The NHS managed that without the roof falling in over the past five years, although the strains are becoming almost daily more evident. Quite how it will manage another five years is highly questionable. Assuming the economy prospers—and in the end everything depends on that—the later years of this spending review will have to be revisited. BJHCM Nick Timmins, senior fellow at the Institute for Government and the King’s Fund, looks at the implications for health and social care following the spending review What to expect after the spending review