Verum writes: Budget holds out very little hope for primary care
My memory of budgets is that the key announcements of interest to the majority of the general public, and which attracted media headlines, were the price of cigarettes, alcohol and petrol. Now the headlines from Phillip Hammond’s first autumn budget are all about Brexit, the price of housing and the NHS, all reflecting general uncertainty regarding the perilous state of the country’s long term economic future.
Whatever is said about funding for the NHS, it should be of interest to the optical industry, as we are a direct beneficiary through eye examination and dispensing fees. However, it goes without saying that the budget had no mention of primary care, other than general practice. As I have said before, optical practice, and to a lesser extent the other primary care disciplines are lower in NHS priorities than the lowest rung on the NHS ladder.
Regarding the NHS, the Chancellor acknowledged the service was under pressure, and announced an extra £1.6bn of revenue funding in 2018/19 for day to day spending plus an additional £3.5bn funding for transformational capital investment and tackling the maintenance backlog over the course of the parliament. How long exactly this will be is anyone’s guess given we have a government, propped up by a minority party. There was also an immediate £350m to help trusts prepare for the winter ahead and full funding for an end to the staff 1% pay cap.
Commentators on the budget acknowledge that there has been extensive lobbying in advance of the budget to Ministers, senior leaders at the Department of Health and HM Treasury. Hospital trusts have not been shy in illustrating the pressures they face. This has finally meant the Government has understood that existing NHS spending plans were undeliverable, with the hope that the budget would be a point in time to put the NHS on a more secure footing.
The reality is an increase in money, which although more than was expected, it is disappointing that the government has not been able to give the NHS all that it needs to deal with rising demand, fully recover performance targets, consistently maintain high quality patient care and meet capital requirements.
It is also notable that the extra revenue has been tied to acute hospital performance at a point when the pressures across the rest of the health service, community, mental health and primary care services, are just as great.
Looking forward, this all means that difficult choices will be needed and trade-offs will have to be made on what the total NHS service can deliver in 2018/19. It is a certain bet that no new monies from the budget announcement will be coming towards optical practice as it will all be invested in secondary care. However, not for the first time I would make the point that this could be an opportunity for optical practice to put forward what we can do to ease the burden on secondary care and enable them to better balance their books.
And what a great case we can put forward. I think it is interesting that if we look at the key issues within the NHS that the budget aims to help; investment in capital, extra money for day to day activity and funds to pay additional salary, it is striking that none are exacerbated by the NHS services we provide. In fact, capital investment, day to day expenses and salaries are all met by optical practice owners and while it is a constant irritation that the NHS fees we receive do not cover the actual cost of the service we provide for the NHS, anyone would have to acknowledge that the NHS gets fantastic value for money.
There may be a significant downside to optical practice as a result of the budget and the following estimations of a slowdown in economic growth and salaries. The bottom line is a downgrading of the growth forecast and signals that the UK economy is weaker than hoped.
My concern is that spending in optical practice is discretionary and when there is reduced public confidence due to uncertainty looking forward, whether it is actual or perceived, then the amount of money being spent on spectacles will reduce. As always, we have to manage any short term downside and take advantage of the opportunities that present as secondary care may at last come to the realisation that there is not going to be a knight in shining armour to rescue it from financial disaster.
Finally, clearly times are changing and surprise, surprise, the cost of the average pint is to stay the same – so as Christmas is coming, may I raise a glass and wish everyone season’s greetings.