Can the NHS and social care be expected to withstand financial pressures as police and defence services have in the past?
This post is from The King's Fund Blog
This is a piece of whimsy. But a serious one that might just be worth the Chancellor and the Prime Minister thinking about before they set the final spending numbers in stone ahead of next week’s Autumn Statement.
Philip Hammond and Theresa May are said, both privately and publicly, to have told head of NHS England Simon Stevens that they had successfully cut the police and defence budgets in their previous incarnations by pretty substantial margins, without any harm being done. So he shouldn’t tell them that the NHS needs more money when it is still enjoying a very limited – though plainly inadequate – level of growth. ‘Just do the efficiencies, dear boy’.
Well. Let’s start with cuts to the police. Pretty much everyone, from criminologists to Her Majesty’s Inspectorate of Constabulary, struggles to find any consistent relationship between police numbers and levels of crime. Sure, if you put large numbers of police on the streets after events such as the 7/7 tube bombings or 2011 riots, crime goes down. If the police go on strike – they don’t in the UK – there is evidence that crime goes up. And there is some evidence that, at the margins, more police officers reduce property crime. But the huge reduction in car crime has resulted not from the number of officers but from manufacturers improving vehicle security. The same may well be true of home security, given the proliferation of alarms and home-based CCTV. So the claim that the police budget has been cut by more than 20 per cent since 2010 without ill effect can’t be proved either way. This is not to say that police numbers do not matter; of course they do. For reassurance on the streets and much else. But the real test of their decline, unfortunately, may come from a sustained major incident of one sort or another, or from a police response time that eventually leaves the public furious.
Or take prisons. Not, as Theresa May must be pleased to remember, part of her remit as Home Secretary, because prisons were hived off to the Ministry of Justice as she got the job. But, as that was a close escape, she may reflect on the fact that prisons have been subject to a 40 per cent cut in officer numbers since 2010, to the point where the government itself acknowledges that there are now completely unacceptable levels of violence against staff and between prisoners, with suicide and self-harm figures on the up. It has now reversed its policy. It has found more money and is seeking to recruit more officers.
And defence. The cuts have been so successful that in 2019 the UK will take final delivery of an aircraft carrier from which it will have no planes that can fly until at least 2020, and more likely 2021. And even then, not many of them. It is possible that in a real crisis the US Marines will bring over their planes to fly from it. And just this week we heard that Britain’s equivalent of the Exocet – the Harpoon anti-ship missile – is being withdrawn in 2018, leaving the country for some years with no equivalent defence for its Royal Navy. Let’s just hope there’s no need to test whether any harm results from this.
Against those assertions of no harm there is the National Health Service and social care. The latter is still being cut year-on-year in terms of the numbers receiving help and the hours they receive. And the NHS is now halfway through what – on current plans – will be a decade of barely recognisable increases in spending per head, despite a population that is ageing and acquiring multiple conditions by the day. And despite the need to reshape services, a need that the government has already acknowledged requires at least some upfront investment.
These are real pressures in real time, with the health service in real deficit. As waiting times and other measures of performance decline, Hammond and May cannot just hope that damage from the continued squeeze will not materialise. It is already doing so. Half a million patients have breached the A&E waiting time in the past three months. Almost 350,000 are waiting longer than the promised time for elective treatment, some more than a year. Delayed discharges from hospital have hit record levels. This list goes on. If something is not done soon, there is a real risk that the massive gains the NHS has made over the past decade and a half – not least on waiting times – will fall off a cliff.