On the podcast recently Joe McManners highlighted that the more government and policy makers talk about shifting resources out of hospital and into primary and community care the less it happens.  Well, we have had the talk in the form of the Darzi report, and now does the budget simply prove his point?

On the bright side, the Chancellor did at least announce new money for the NHS.  £22.6bn was announced over 2 years, but the narrative that she used to go with it was painfully familiar, “Because of this record injection of funding, because of the thousands of additional beds that we have secured, and because of the reforms that we are delivering in our NHS, we can now begin to bring waiting lists down more quickly and move towards our target for waiting times to be no longer than 18 weeks by delivering on our manifesto commitment for 40,000 extra hospital appointments a week.”

It seems the chancellor didn’t get the memo from Darzi.  When we look at the detail of what the money is for (although the Kings Fund have indicated the majority of it will be needed to fund the already published workforce plan) there are specific capital projects identified:

• 40,000 extra operations and acute sector appointments a week
• £1.5 billion for capital for new surgical hubs and scanners and new beds
• £70 million for radiotherapy machines
• Fixing RAAC (reinforced aerated autoclaved concrete) hospitals
• £2 billion to invest in NHS technology and digital – contingent on 2 per cent productivity next year
• A dedicated fund to deliver around 200 upgrades to GP surgeries (£100M “earmarked”)
• £26 million to open new mental health crisis centres

The majority of these are secondary care focussed.  The primary care and mental health items at the end look very much like someone noticed this and added them on at the last minute.  Anyone who has been involved in the development of new GP surgeries will know that half a million does not get you very far, and even 200 developments isn’t going to touch the sides of the need across the 6000+ practices out there.  And of course no one is going to be surprised if even that money comes with caveats about “neighbourhood working”, or if it gets forgotten when NHSE decide they need the money for something else.

In fact general practice does not even get a single mention in the budget.  This does not inspire hope that the service will then be at the front of the queue for investment when the much touted 10 year plan arrives in Spring.

The new government has talked about shifting care from hospital to the community and shifting from treatment to prevention, and has raised our hopes via the Darzi report which called for a “hardwiring of financial flows” to lock in the shift of care closer to home.  So it is somewhat depressing to then receive a budget which ignores this altogether and goes back to funding more activity in hospitals.

But the Prime Minister has continued to insist that the government will focus on reforming public services rather than simply spending more on what we currently have.  It may be that this budget is what is needed as a short-term fix to prevent the NHS deteriorating further, before the promised reform plan is published next year.

Let’s hope that what it is.  If we are being honest we are seeing an early gap develop between the rhetoric and the action, but it feels too early to give up just yet, and hope still remains that this government will provide the investment for primary and community care in future that is needed to prevent the NHS becoming even more hospital-centric.