The RCPod response to the Spring 2023 budget

The speech was delivered on the day that teachers, junior doctors, civil servants, London Underground staff, and local BBC journalists were out on strike. The Chancellor is dealing with a low growth economy, under investment in public services, no significant wage growth, a high rate of inflation, high food and fuel prices.

This Budget comes at a time when the Office for Budget Responsibility (OBR), an organisation that is independent of the government, estimates a decline in the level of UK productivity of approximately 4% by the end of the 2020s. The OBR say this is due in no small part to the UK leaving the EU. The OBR has predicted that the UK economy will contract by -0.2% this year. However, the UK economy is forecast to grow by 1.8% in 2024; 2.5% in 2025; 2.1% in 2026; and 1.9% in 2027. The OBR has forecast inflation to fall to 2.9% by the end of 2023, from current levels of 10.7%.

Health

The former Health Secretary and former Chair of the Health and Social Care Committee announced that reforms to annual and lifetime allowances will stop over 80% of NHS doctors from receiving a tax charge. This is part of a wider package to make remaining in work more attractive for ‘older workers.’

The Chancellor said that high inflation is the root cause of the strikes. In truth, public sector workers are not only striking for their wages to keep up with inflation to prevent them from slipping further into poverty; they are also striking to prevent the wilful decimation of public services through continued under investment. The Chancellor pledged to resolve ongoing industrial action, but only whilst not increasing inflation. The only way to resolve the strikes is for each appropriate Minister to sit around the table with the relevant trade union(s) and negotiate. It is peculiar that if this government, as they continually profess, loves the NHS, value education, and wish to encourage use of public transport, they are not prepared to invest in the workforce that runs these services. Podiatry, as with many other health professions, has high vacancy rates. They are not going to be filled if pay is kept at below inflation rates, and every future increase has to be fought for tooth and nail.

£10m has been allocated for the next two years for the voluntary sector to help prevent suicide. In the UK 15 people die by suicide each week; 75% of those deaths are male. One in five people have suicidal thoughts, one in 14 people self-harm, and one in 15 people attempt suicide. Therefore £10m may only scratch the surface of addressing this serious issue.

The Chancellor also announced, in a bid to help more people back into work, employment support for Mental Health and Musculoskeletal services. He said: “Scaling up Musculoskeletal (MSK) hubs: we will turn community hubs and leisure centres into MSK hubs which deliver evidence-based support for MSK conditions in England so more people can access treatment.” We await to see what this will mean in practice, but we are working closely with the Arthritis and Musculoskeletal Alliance to ensure that podiatry will be part of any multidisciplinary hubs.

There is a need to invest in public health schemes throughout the life course. This is to ensure that we have a population that looks after their physical and mental health, through exercise and maintaining a balanced diet. One of the many ways people stay healthy is through swimming. At a time when 382 public pools have closed in England in the past 13 years, the PM’s local electricity grid had to be upgraded to meet the power demands to heat his own swimming pool. Therefore, we welcome the £63m investment which will be hosted by Sport England and hope to see a large number of these accessible and affordable pools reopening.

A new Universal Support programme was announced to help disabled people and those with long-term conditions find jobs and remain in work.

There were no announcements about social care, which continues to be the can that is kicked down the road. Yet if it were tackled, we would see a positive impact by freeing up acute beds, thereby reducing ambulance waits. Thought and investment should be put into intermediate care for those needing short-term rehabilitation after a hospital stay, before going back into their own home. There was nothing on an NHS workforce plan; however, we are aware that NHS England is due to publish one within the next few months.

Childcare

As a profession that is 75% female and given that the vast majority of childcare still falls on women, we welcome the 30 hours of free childcare per week for all under fives. This will make a huge difference to young families. It is, however, 30 hours of free childcare for every child over nine months in households where both adults are working. It will be staggered; 15 hours free for two-year-olds from April 2024. From September 2024, all children from nine months will be entitled to 15 hours of free childcare, and from September 2025 all parents will be entitled to 30 hours per week. There was no mention of where the childcare capacity was likely to come from, or what services are likely to see cuts to fund the £4bn scheme, which will not fully roll out until after the next general election.

The Chancellor said that ‘the plan is working.’ The vast majority of the population, who see their income decreasing and struggle with increasing food and fuel bills, and stagnant wages, may query exactly what the plan is. Less certain is how it works for them in the short or long term. Whilst there are areas to support this budget, it appears that there are also gaping holes and unjoined dots that the Chancellor is happy to leave for whoever comes into government after the next general election.