Rishi Sunak's cash influx can’t protect public services from a second coronavirus wave

The chancellor’s Winter Economic Plan showed that the government has approved £68.7 billion of additional funding to help public services respond to the coronavirus crisis, including £24.3 billion since July. A further £12bn has been allocated for Test and Trace.

This is a huge amount of money, equivalent to nearly two thirds of the normal annual NHS budget, and it has allowed government to fix some of the biggest problems faced by public services in the first wave. However, even with this influx of cash, key services like hospitals, adult social care, general practice and criminal courts will struggle to cope with another severe outbreak of infections.

Lessons have been learnt – and investments made – since the crisis first hit

Ahead of the crisis, public services had plans for dealing with a pandemic. However, these were focussed on influenza. Critically, this meant that little consideration has been given to how services could be delivered while maintaining social distancing, be that GPs working from home, pupils being taught remotely, or criminal trials taking place via video link. Similarly, personal protective equipment (PPE) stockpiles were missing vital equipment such as gowns and visors.

On all these counts, public services will be better prepared for a second wave. The government has spent billions of pounds on PPE. Hospitals and GP practices have been redesigned their facilities to separate patients with and without coronavirus, and the government has built new nightingale hospitals and courts to provide extra capacity. There is had also been a major investment in technology to enable remote working.

However, while these changes are welcome, they are not enough to maintain the availability or standards that we usually expect from public services. For example, while greater use of video, telephone and messaging platforms have prevented services from grinding to a halt, they can be less efficient than working face-to-face and result in lower quality care from the NHS, teaching from schools and justice from the criminal courts. Waiting lists have also grown and will continue to do so while services are suspended or running below normal capacity. This pent-up demand for help could mean that there is even more pressure on public services during the second wave than there was during the first.  

Key public services continue to suffer from under-staffing

The massive ramping up of budgets has made it possible to buy millions of items of PPE, ventilators, computers and even temporary buildings. But tens of thousands of experienced nurses, prison officers or care workers cannot be purchased into existence. Over the past decade, governments made cuts to public spending through redundancies and holding down wages. While that may have been a reasonable policy decision at the time, it meant public services entered the crisis with major recruitment and retention problems, and fewer frontline staff per capita than many other developed countries. The NHS alone had 90,000 vacancies on the eve of the pandemic.

In the short term, public services have coped by redeploying staff, relaxing regulations, and drafting in volunteers and retirees. But this is not sustainable. Staff have been physically overstretched, while the mental toll of working on the frontline throughout the pandemic should not be underestimated. Some members of the public may object to wearing masks when popping to the shops, but many NHS staff must wear them for 14-hour shifts, and have been doing so for six months straight. Meanwhile, poorly paid care workers have been asked to provide tender support in care homes in which residents may be unable to see their families and where there have been 30,000 excess deaths. There is a real risk of burnout if things get worse in the winter.

The chancellor said the government had “met our promise to give the NHS whatever it needs”. But his statement does not make up for years of allowing staff shortages to grow. As the winter takes hold, and public services gear up for the second wave of Covid-19 infections, the greatest problems is not how services are delivered but who delivers them.