George Osborne has said he will give an extra £3.8bn to the NHS in England next year. Ministers have previously pledged an additional £8bn for the health service over the next five years, so the news today is basically that the NHS will be getting a large slab of that money earlier than the rest, in what is termed frontloading.
So what should we make of it? As is often the case with such announcements, there is an element of smoke and mirrors about it, which should set a few alarm bells ringing. The government has unveiled the good news – more money for the health service – but expect the devil in the detail tomorrow and during the coming months.
Basically, to help pay for the extra money for the NHS, cuts are widely expected to the budgets for public health and education, which are apparently no longer deemed to be within the “ringfence” of protected NHS spending.
This will almost certainly see an end to free nurse education for nursing students, with the current bursary system replaced by loans. A highly controversial move, even within the profession itself.
It also means local authorities will be under pressure to find more savings on top of the 6.2% in-year cut they are already having to shave off public health budgets in 2015-16. Almost certainly bad news for health visitors, school nurses and all other specialist public health nursing staff!
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So, let’s deal with public health first. Has the dream already turned sour since the much lauded transfer of public health commissioning from the NHS back to councils? While seen as its traditional home, the move to local authority control has seen it suddenly vulnerable to cuts.
Admittedly, there may be some innovative service design forced through as a result, for example the merging of currently separate nursing services for 0-5s and 5-16s, which may not necessarily be a bad thing. But, as ever, staffing numbers could take a hit – including the hard-won gains to health visiting workforce – and lots of other local initiatives and schemes could be axed.
I’ve listened to doyens of the sector like Sir Michael Marmot eloquently and forcefully explaining how long-term investment in public health and prevention is really the key to reducing the ever increasing pressure on the NHS. Their evidence is compelling and their calls for public health funding to be on a much longer cycle than the four-year parliamentary merry-go-round are unshakably logical, as far as I’m concerned.
However, once again, it seems that funding streams for preventing ill-health will be cut at the expense of those for treating the resulting conditions. Is it simply that public health as a collective term is seen as less “sexy” with the electorate and headline writers than the NHS – possibly!
Cuts to budgets for public health are short-sighted whatever the reason. Reducing the number of contacts with NHS services by improving the overall health of populations is surely a better answer than building more and more hospitals, especially when we are struggling to staff them.
And so to the question of future funding for nurse education. If reports are correct, tomorrow could see the beginning of the end for the student nurse bursary. Unsurprisingly this is an idea that brings out strong opinions.
I remember having a blazing row with a friend over the then government’s policy to do-away with student grants in the middle of the 1990s. It was something I felt really passionate about, having been the first in my family to have the opportunity to go to university.
Likewise, current students will be nervous about how they will pay their way in the remaining years of their course and unions have warned it will put off potential recruits – some nurses on social media site Twitter have already been reflecting on whether they would have entered the profession without a bursary.
But on the other hand, some argue that the bursary does not really provide enough money to live on and that a loan would mean students were better off in the short-term, though obviously saddled with repayments later. It would also bring nursing and midwifery into line with other professions, where student grants have long been a thing of the past.
There are several factors to consider here. Does putting nursing on a level playing field with other university courses make it less appealing to potential students? Nursing is often viewed as a vocation, so many may continue on their chosen career path, regardless of bursaries or loans.
Equally, perhaps moving to a loan might weed out students who have chosen nursing simply because it does come with a bursary and are not really best-suited to the profession – sorry, a controversial point, I know.
But it could also be argued that a loan is more of a problem for a nursing graduate than many other professions, simply on the grounds of the future pay levels they can expect compared to other graduates. In addition, there is a perception – rightly or wrongly – that many of those choosing nursing come from less well-off families than, say, doctors, architects or lawyers. This may disappear, as nursing becomes increasingly established as a graduate profession with ever more specialist and expert skills, but there have been warnings that, at present, loans could represent a financial barrier to some.
And what of student doctors and dentists. There has been no suggestion, as yet, that they will lose their bursaries, despite the fact graduates in these subjects can look forward to commanding much, much greater salaries than even the best-paid nurses. Does the government think it already has enough of a fight on its hands with the British Medical Association over junior doctors’ pay?
It should be noted that one of the key drivers behind the change were the universities themselves, who have lobbied ministers on the idea and, in turn, been quizzed by the Treasury on how it might work.
As reported by Nursing Times, they have championed a move to loans because it will give them the flexibility to open more places on nursing and midwifery courses if they wish, rather than being constrained by the number of bursaries available from Health Education England. It means they can make more money, basically, but it could potentially break the boom and bust cycle of workforce supply that seems to dog nursing in the NHS.
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A final point to end on. While clinical commissioning groups and their provider organisations will no doubt be very pleased today with the promised extra £3.8bn in the pot for next year, there are likely to be caveats on how they spend the cash injection.
Runaway trust deficits and winter pressures aside, NHS England will want some of the money to be used to pump-prime the new models of care outlined in its Five-Year Forward View and the government will almost certainly be setting targets for introducing its promised seven-day service.
We await the detail and its devils within from the chancellor tomorrow.