What does the Spending Review mean for child health?
If you’ve had a glance at any of the reporting on the publication of the Spending Review, or heard a snippet of the speech the Chancellor made this afternoon, you would be forgiven for answering this question with a variant of “not a whole lot.”
In reality though, child health is almost always affected by the broad direction of travel in terms of economic policy (and the state of the economy), and today’s Spending Review is worth unpacking in that context.
The lack of a specific focus on child health was not unexpected. In light of the on-going pandemic and what the Chancellor’s team has trailed in the media, we knew that the Spending Review would focus primarily on, “protecting jobs and livelihoods.” We were due to have a Comprehensive Spending Review this autumn — a governmental process carried out by HM Treasury to set firm expenditure limits and the spending requirements for all government departments over a number of years.
The scaling back of the scope of the Spending Review has significant consequences for child health in the UK. For a number of years, health organisations, including us, have been calling for a long-term public health funding settlement for Local Authorities. Under ever-increasing pressure, Local Authorities now face another year of knowing only what they have available to fund the public health services they deliver for the next 12 months. This undermines the ability to take a prevention-centred approach to these services, which is vital to improving child health outcomes.
Last month, we were told that we would instead have information about spending limits and requirements for the next financial year only. This, in the current economic context, is understandable. The Office for Budget Responsibility (OBR) has today published their economic and fiscal outlook for the coming years. It doesn’t make for easy reading. They say the economy will contract by 11.3% this year; the greatest fall in over 300 years. They predict this will translate as a rise in the unemployment rate to 7.5%, or 2.6 million people. The sad reality is that the economic cost of COVID-19 that we’ve seen so far is likely the tip of the iceberg, and this has the potential to have a devastating impact on child health outcomes across the UK.
We know that health outcomes are socially determined. By any measure, rates of child poverty in the UK are rising. The OBR forecast means this is almost certain to get worse.
Our State of Child Health project, that has run over a number of years, has consistently shown that poverty and inequality impact a child’s whole life, affecting their education, housing and social environment and in turn impacting their health outcomes. Unemployment is of course linked to poverty, but 70% of children in poverty are living in a household where at least one parent works.
One of the key announcements from today’s Spending Review was the £2.9 billion announced for the 3-year Restart scheme which will work to help people get back into employment. This will theoretically see a welcome increase in household income for many thousands of families. It will also help those young people that find themselves out of work in the coming months as a result of COVID-19. The proportion of young people unemployed is always higher than the overall unemployment rate, and young people not in education, employment and training have worse mental and physical health outcomes than those who are.
The Chancellor also announced today that the National Living Wage would increase by 2.2% to £8.91 an hour. The application of the National Living Wage has been expanded from those 25 and above to those 23 and above. Given the statistic regarding the proportion of children living in poverty with at least one parent in work, this is good news.
On the matter of pay, the Chancellor confirmed the speculation that there will be no ‘across the sector’ pay rise for public sector workers. Exceptions are made for the 2.1 million lowest paid public sector workers who earn less than £24,000, who will receive a minimum pay increase of £250 a year. These measures are being introduced with the objective of stymieing an increase in poverty rates as a result of the anticipated economic recession. Doctors, nurses and other health professionals are also exempt from this pay freeze
There were a number of announcements relating to other departmental areas that will have significant impacts on child health outcomes. The decision to reduce the established commitment of spending 0.7% of GDP on international aid to 0.5% will have consequences for children across the globe.
As I said at the start of this blog, you would be forgiven for thinking there was little relevant to child health in today’s Spending Review based on an initial assessment. The reality is that most areas of policy impact child health to some degree.
The policy-making process in the UK is segmented and operates in departmental silos. This is a particular problem for child health. RCPCH has been vocal about the need for a cross-government approach to policy-making for some years. Our headline call to Government for a Children and Young People’s Health Strategy aims to embed a joined-up approach to formulating policy; assessing the impact of all policies on CYP health outcomes and working to improve them.
Therefore, it’s promising to see the announcement of a number of initiatives, such as the Levelling Up Fund; £4 billion for local projects that will extend cross-government working between the Treasury, the Department for Transport and the Department for Housing, Communities and Local Government.
This big picture approach is the only way the Government can fulfil their headline election pledge to level up the country. We strongly support this aim and set out how Government can do this in our submission to the CSR. We hope that these initiatives signal a willingness within Government to do things differently in the future. We will continue to make the case for the adoption of a Children and Young People’s Health Strategy, and adequate support for children and families, as we move through these difficult economic times.