Headlines pile pressure on the Chancellor pre-Budget

'Winter is coming’ for the NHS

Chancellor Phillip Hammond was right to move to a single fiscal event, but he might regret putting it in the autumn, the time of year when stories about winter pressures in the NHS dominate the headlines. There are serious pressures in the health sector and the Government knows it, pledging an emergency £100 million in the spring Budget, to pay for GPs to help clear A&E departments.

And the stories keep coming: today the Chief Executive of the Care Quality Commission, Sir David Behan, pronounced the situation in the NHS as “precarious”, highlighting the challenge of maintaining quality in the face of rising demand.

Meanwhile Health Secretary Jeremy Hunt casually announced today that the NHS pay cap had indeed been scrapped, but refused to offer further details about how it would be paid for. His mention of ‘productivity improvements’ being agreed with the Chancellor does, however, suggest that it may be at least partially funded from within existing budgets.

Just a few hours later, giving evidence in front of the Health Select Committee, both the Chief Executives of NHS England and NHS Improvement made clear that this would not be acceptable: pay increases, they said, have to be funded. If the Chancellor decides not to allocate new money for this change, he and Hunt must make clear what the trade-offs will be.

Once a service reaches a point of crisis, it can be difficult to turn it around

The Government took too long to recognise the mounting problems in prisons and the stories have since been unrelenting. The latest is a damning report from HM Inspector of Prisons which highlights overcrowding, poor sanitation, and problems arising from prisoners remaining up to 22 hours a day in their cells.

The latest data also shows that violence in prisons is continuing to rise. The recently-announced pay rise for prison officers is a necessary step on the road to remedying these issues.

Extra cash can't and won't be the only response to the pressures

The Office for Budget Responsibility warned today that it will offer a more pessimistic picture of the Chancellor’s fiscal headroom in its pre-Budget forecast than previously projected. This means there will be little spare cash knocking around for politically-motivated handouts – and there is the small matter of Brexit preparations competing for any spare resources.

This could be a good thing: a lack of money available for short-term sticking plasters could force the Government to get serious about the long-term transformational changes that made insufficient headway in the last Parliament.

We will publish the second edition of our Performance Tracker, produced in partnership with the Chartered Institute of Public Finance and Accountancy, next week. In it, we reveal in more detail where the real pressures lie across a range of public services – and what the Chancellor's best options are for tackling them.

Join us for the launch of the next edition of Performance Tracker from 12:30pm on 19 October, with a response from Nicky Morgan MP, Chair of the Treasury Select Committee.