Five thoughts on what the Chancellor’s spending review means for people affected by cancer

This piece first appeared on Macmillan Cancer Support’s ‘Evidence and Influence’ blog in December 2015

It was widely reported last week that George Osborne has committed billions of pounds of ‘extra’ money for the NHS over the next five years as part of his Comprehensive Spending Review. But what is the bigger picture for healthcare, social care and welfare, and what will the announcements mean for people affected by cancer?

1. Extra funding for the NHS is welcome — but it needs to be spent wisely

It is good to hear the government is investing in the NHS’s plan for the next five years, and that £3.8bn extra will go into the NHS next year; our creaking health service badly needs this money now.

But three quarters of England’s hospitals are now running a deficit, which by the end of the year is expected to hit £2bn. We have seen the impact of this pressure on frontline cancer services: cancer waiting time targets have now been missed for seven quarters in a row. In the short term, the extra money will help to plug the black hole in NHS balance sheets, which we hope will mean getting back on track with meeting existing targets.

It is now crucial that the government spends wisely and fully funds and implements the cancer strategy for England which will be transformational for cancer care. Although the cancer strategy was mentioned in the Spending Review, this was only to reiterate a commitment to implement the previously announced recommendations on a new 4-week target for diagnosis and improved diagnostic capacity through £300m in funding.

As we said in October, time is running out: by 2020, there will be half a million more people living with a cancer diagnosis in England than in 2015. The strategies and solutions to support this growing population and avoid further crises have been agreed — what we need now is action. Macmillan will continue to push for the cancer strategy to be implemented in full.

2. We often hear that to have a strong NHS we need a strong economy — but despite extra funding, the NHS is not receiving its fair share of the proceeds of growth

The Government has often said that we need a strong economy to have a strong NHS. The reverse is just as true — we need a strong NHS and a healthy population to have a strong economy. As the economy returns to growth, we should invest in the long-term health of the nation. But on the evidence we saw in the Spending Review, it looks as though health and social care funding are going in the opposite direction.

Billions of pounds of extra money is a big investment, but as the population ages, more treatments become available and more people survive diseases such as cancer, the demand for healthcare could still outpace funding. Even with the additional money, we are now mid-way through the longest decline in NHS funding as a percentage of GDP since the war:

Source: King’s Fund

What does this mean for cancer services? The picture is unclear: we don’t yet know how the NHS will use its funding allocation, and will find out more when NHS England’s plans are published in early 2016.

What we do know is that between 2010–2013 spending per cancer patient had already fallen by between 4–10% (the latest figures available).

It can be difficult to know whether healthcare funding necessarily leads to a healthier society, and not all high-spend health services get value for money, but there comes a point where it is clear that more could be done with additional funding, and this is true of cancer.

In comparison with the rest of the world, both our level of healthcare spending and our cancer survival rates fall short. Last week’s announcement means that over the next five years, the share of GDP the UK spends on the NHS will fall even further below European and OECD averages:

Source: Nuffield Trust

3. Cuts to public health and bursaries for nurses are counterproductive

We understand much of the extra £3.8bn for the NHS next year is in fact sourced from a 25% cut to the Department of Health’s non-NHS budget.

It is counterproductive that ‘extra’ NHS money is being sourced from cuts to public health (which includes cancer screening and smoking cessation clinics) and bursaries for student nurses. This precious investment should be used to drive genuine progress — instead, it is being used to paper over the existing cracks.

Local authorities’ public health budgets will also fall by an average of 3.8% in real terms each year. The public health ring-fence will be ‘maintained until 2017/18’, which implies it might not continue afterwards.

This means the Spending Review has failed to meet one of the ‘five tests’ set by the head of the NHS, Simon Stevens, for the Spending Review — to “make good on the public health opportunity”.

4. We’re still concerned about social care funding

Funding the health service is just one side of the coin. The needs of people living with cancer are often life-long, and many require non-medical support to get by.

We are concerned that continuing pressure on social care budgets means that extra funding given to the NHS could end up being spent propping up a cash strapped social care system.

George Osborne announced a new optional levy on council tax of up to 2% per year, which is to be ring-fenced to fund adult social care. But commentators are suggesting that even if this is implemented by every council each year there will still be a substantial funding gap.

Perhaps even more problematic is the risk that access to social care could become more of a postcode lottery and exacerbates health inequalities by disadvantaging councils with weaker tax bases. According to the Institute for Fiscal Studies, councils such as Manchester, Hackney, Liverpool, Newcastle and Birmingham could only raise an extra 4%, while Richmond and Windsor could raise 17–18%. Meanwhile the King’s Fund warned the measures “are not a substitute for sustainable funding”.

No other advanced economy is reducing the share of national income spent on social care, as the UK is doing. We know that during the first few years of the last parliament’s social care cuts, over 360,000 fewer older people received social care than before. It is difficult to be optimistic about the future of social care against this background.

5. The welfare situation has changed less than the headlines suggest — and we will do all we can to be there for people affected by cancer

One of the big headlines after the Spending Review was the government’s supposed u-turn on its controversial proposals to cut Tax Credits. While we welcome this change because we know many people with cancer use this financial support, this is only a short-term gain, as the same cuts will continue to apply to Universal Credit, which is already being phased in.

Despite talk of u-turns, the impact of tax and social security changes over the next four financial years will be the same as first estimated after the July Budget statement (the poorest 20% will still be around 7% worse off). The Chancellor also reiterated his commitment to implement £12bn of savings, part of which is the already announced cut to ESA WRAG, which we are campaigning to stop.

Macmillan believes it is vital people affected by cancer get the support they need through the social security system, so monitoring and responding to the introduction of Universal Credit will continue to be an important part of our work.

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