This week, Chancellor of the Exchequer Philip Hammond presented his first – and last – Spring Budget to the House of Commons. The Budget contained a handful of notable policy decisions for health and social care, including £325 million of capital funding to support Sustainability and Transformation Plans (STPs), £100 million of capital investment for A&E departments and £2 billion for social care – but these did not match the demands of the health sector. Stakeholders such as the Royal College of Nursing and the Local Government Association welcomed the funding announcements, but highlighted the need for further measures to resolve the wider financial difficulties in health and social care.
In other news, Health Education England (HEE) Chief Executive Professor Ian Cumming has said he expects a further 2,000 new nursing associate trainees to start two-year training programmes in 2018. Some 1,000 trainee nursing associates started programmes at pilot sites across England in January, with a further 1,000 due to begin at more test sites in April. Speaking at a HEE board meeting, Professor Cumming said the organisation will be working with employers to understand how the forthcoming apprenticeship levy can fund a faster roll-out of the programmes in the future.
Meanwhile in a blow to the Government’s plans, the House of Lords has voted in favour of another amendment to the European Union (Notification of Withdrawal) Bill, to allow Parliament a veto over the outcome of negotiations. The Government has said it will attempt to overturn the Lords’ amendments when the Bill returns to the House of Commons next Monday. Any “ping pong” over the Bill’s final wording will conclude next Wednesday, and so is not expected to delay Article 50 being triggered.
Spring Budget 2017
Chancellor of the Exchequer Philip Hammond has this week presented his Spring Budget to the House of Commons. As previously announced, this was the last Budget to be made in the spring. The first Autumn Budget is due later this year and will be followed by a Spring Statement from 2018. The Office for Budget Responsibility (OBR) confirmed better than expected growth rates, with the growth forecast for the UK economy for 2017 rising to 2% from the 1.4% predicted last November, and government borrowing is expected to be approximately £16.4 billion lower this year than previously anticipated.
The Chancellor announced increases to National Insurance for self-employed people to bring contributions in line with that for employed workers, making the case that lower NI paid by self-employed workers is estimated to cost approximately £5 billion this year. The policy has since prompted substantial backlash from backbench Conservative and Labour MPs, with the Prime Minister now stating that a vote on the changes will take place in the autumn.
Health and Social Care
In an unexpected boost for the NHS, the budget announced £325 million of capital funding to support the “strongest” Sustainability and Transformation Plans (STPs) over the next three years. The Chancellor said the funding will go towards areas such as building new healthcare premises and investing in new technology, which many STPs have said is crucial to ensuring their new models of care are successful. A further round of capital funding for STPs will be announced in the autumn, again predicated on the “strength” of an STP.
The budget also includes £100 million of capital investment in 2017/18 for A&E departments. This funding is expected to deliver an urgent treatment centre, based on the model of Luton and Dunstable University Hospital Foundation Trust, in every A&E in England, which will triage patients and send them to the appropriate healthcare professional. The Chancellor said the money “will enable trusts to invest in measures to help manage demand on A&E services”, and could include locating GPs within A&E departments.
Responding to growing pressure from MPs and stakeholders across the political divide, the Chancellor also announced that the Government will provide an additional £2 billion for councils for adult social care between 2017/18 and 2019/20. £1.2 billion of the new funding will be available in 2017/18, followed by £800 million in 2018/19 and £400 million in 2019/20. A Green Paper on a long-term solution for social care funding will be published later this year.
As expected, the Government announced £320 million of new funding to expand its free schools programme, which will enable new selective schools to be created. This will support the creation of up to 140 new free schools, 30 of which will open by September 2020. In addition, children in receipt of free school meals will now be entitled to free school transport to the nearest selective school in their area – a measure designed to further support the expansion of selective schools.
Responding to the Budget, Labour leader Jeremy Corbyn accused the Government of producing “a Budget of utter complacency about the state of our economy” and said the Budget did not provide the funding necessary to end the “state of emergency” in social care. Shadow Chancellor John McDonnell said the Budget will do “nothing to fix the NHS crisis”.
The Royal College of Nursing’s (RCN) Chief Executive Janet Davies echoed these views, stating that the “Chancellor missed an opportunity to give the NHS the level of investment he knows it needs.” She welcomed the financial support for STPs, but called on the Government to clarify the number of plans that will benefit from the new funding and guarantee that it will be directed towards “struggling community services”.
Local Government Association Chairman Lord Porter said the £2 billion for adult social care “marks a significant step towards protecting the services caring for the most vulnerable in our communities over the next few years”, but warned that a local government funding gap of £5.8 billion by 2020 will require further cuts to local services, including social care. He said the “social care crisis is far from over” and suggested the Government’s Green Paper is the “last chance” for a long-term solution.
New funding for children with SEND
Minister for Vulnerable Children and Families Edward Timpson has this week announced £215 million of funding to increase school capacity for children with special educational needs and disabilities (SEND). The Government have allocated at least £500,000 for every council to expand and improve their special educational needs and disabilities (SEND) provision, with more than half receiving at least £1 million. Councils will have full control over how they invest the money to improve education for pupils with SEND, but will be expected to consult local parents, carers, schools, and other stakeholders before making decisions. They will also be obliged to publish a plan showing how they will spend the funding.
Mr Timpson said the Government is determined to build a country “where every child has an equal opportunity to reach their full potential regardless of their background, and any challenges they may face.” He said the new funding will “enable local councils to build new classrooms and improve facilities for pupils, ensuring that no child is left behind.”
HEE publishes plan to attract more nurses to primary care
Health Education England (HEE) has published a plan to improve the recruitment, retention and return of general practice nurses (GPNs), following concerns that an increasing shortage of practice nurses, and an impending retirement bubble, is adding to the workforce pressures in general practice. HEE’s ‘General Practice Nursing Workforce Development Plan’ sets out 17 recommendations, including a national campaign to raise understanding of general practice nursing role across healthcare organisations, schools, colleges and the public; an increase in the number of pre-registration nurse clinical placements in general practice; and recruitment and support schemes to attract newly qualified nurses. Of greatest relevance for the PCF, it suggested GPNs and school nurses running joint school/general practice wellbeing initiatives on school premises to raise awareness.
HEE stated in the report that improving recruitment and retention of general practice nurses is largely the responsibility of individual GP practices, GP federations and emerging new care models, including multi-specialty community providers. It said that clinical commissioning groups, and training hubs being developed by Health Education England as part of efforts to support and develop general practice, will nevertheless have “a crucial part to play” in ensuring the workforce remains sustainable.
Dr Peter Lane, the GP who chaired the group of experts responsible for the report, said the general practice nursing workforce of today provides “an essential, high standard of care to their local populations and are invaluable members of primary care teams”. He said the report “offers clear guidance and steps that can be taken to improve general practice nurse recruitment and retention, and encourage nurses to return to the profession.”
Latest NHS staff survey highlights concerns over understaffing
NHS England have published the results of their latest staff survey, showing that almost half of NHS workers believe the service is understaffed and that this affects their ability to provide care. Out of 409,000 responses, 47% of staff said they disagreed with the statement: “There are enough staff at this organisation for me to do my job properly.” Only 32% agreed with the statement. Meanwhile, 60% of staff reported coming to work in the previous three months despite feeling unable to perform their duties or the requirements of their role, and 59% of staff reported working unpaid overtime each week. The proportion of staff feeling unwell because of work-related stress is at its lowest reported level in five years, but still stands at 37%.
The RCN’s Chief Executive Janet Davies said the figures show how NHS staff are “straining to hold things together”. She urged the Government to provide the NHS with the funding necessary to keep patients safe and wards appropriately staffed, adding that ministers should offer nurses and health care assistants a pay rise in line with the cost of living. She said: “Unless the Government shows it values those working under immense pressure and taking care of patients when they are most vulnerable, people will be deterred from joining the nursing profession and others will feel no choice but to leave it.”