Health in focus: Run-up to the Budget

As Labour continues to slide in most polls, tensions between Secretary of State for Health and Social Care Wes Streeting and the British Medical Association (BMA) continue to surge.

Most recently, the BMA rejected another pay offer from the Government which included covering the cost of exam fees and greater training capacity. Streeting has said the strikers are ‘unnecessary and irresponsible’, the state will not be held to ransom by the doctors and challenged the notion that a 28.9% increase in pay was not the ‘crumbs’ that was being described. With the NHS experiencing its highest demand over the summer and the inevitable winter crisis that looms in the near future, the importance of maintaining the supply of healthcare is paramount. The issue that looms for Streeting is that he must balance the ‘whip’ of the Treasury, who already is squeezed for cash, with the ambitious targets on elective waiting lists which become hampered by the strikes over pay.

To counter these waiting lists, the Labour Government is keen to stress the importance of innovation in the NHS, with what seems like daily press releases on a new technology or pilots that will improve access, speed up care, and cut down the waiting lists. Despite this, the constant recurring theme seems to stick to ‘money’. On the macro level, last year’s Budget saw a £29bn uplift to fund the inherited crisis and on the micro level, both the resident doctor strikes and the crisis in pharmaceutical investment, shows that innovative string to Streeting’s ‘bow’ can only go so far, and he inevitably ends up at the door of No. 11. Kemi Badenoch would likely tell you to ban the strikes to free up cash that could be sent to the pharmaceutical industry, a decision that could implode any state relationship with resident doctors and the BMA. This would likely harm productivity and efficient healthcare, but more widely for Labour, any worsening of tensions with the health workforce would strike a dark tone for the Government of disavowing the very labour it names itself after.

Elsewhere, the National Institute for Health and Care Excellence (NICE) appeared in front of the Science, Innovation and Technology Committee to explain their involvement in life sciences investments. A key criticism of NICE has been on their QALY threshold, which has remained at £20,000-£30,000. CEO Dr. Sam Roberts specifically outlined that the QALY threshold is designed to model how the public see the health-to-cost ratio for the length and quality of life. The process of QALY’s, notably through the EQ-5D-5l assessments, was also criticised due to its subjectivity and limitations in assessing chronic illnesses. In PMQs last week, Jonathan Brash criticised NICE for not permitting omaveloxolone to treat Friedreich ataxia on the grounds that it couldn’t be classified as an ultra-rare disease. Fundamentally, NICE is being criticised by two sides of the same coin, one, to expand medicine provision to improve health outcomes, and the other, to expand provision to decrease life sciences disinvestment. In the committee, Dr. Sam Roberts noted that movement of the threshold is ultimately a Government decision and will either come at a cost to the public purse or will lead to cash being strapped from other areas in health or the wider economy.

In Parliament, two high-profile Bills have begun to make their way through committee stage, the Terminally Ill Adults (End of Life) Bill and the Tobacco and Vapes Bill. The Terminally Ill Adults (End of Life) Bill has drawn up a strong level of media attention and is now in the process of being scrutinised by the Lords. The Lords have held oral evidence sessions for the Bill, an uncommon process for Bill committees but one that highlights the desire to scrutinise the Bill further. This included a session with relevant stakeholders from New Zealand who previously implemented a similar Bill titled End of Life Choice Act in 2022. Members heard of the threat of the Bill’s expansion through bureaucracy and the challenges it brought to palliative care, as well as the benefits of gratitude and relief that the Bill brought to families. Notably, with a recent NAO report finding that nearly two thirds of adult hospices reported a financial deficit in 2023-24, any further burden placed on this sector through the administrative complexity and social consequences of assisted dying legislation could further jeopardise any stability left in the sector.

One of the most prominent recent Parliamentary debates was on baby loss, tabled by Andy MacNae as part of Baby Loss Awareness Week. The debate included powerful speeches from Members of Parliament, some of whom had personal experiences to share. The debate highlighted the failures of maternity care, which have prompted the national investigation into maternity and neonatal care. This included experiences of ‘overt racism’ and clear cases of avoidable harm and loss. In a written response to one of the debate’s contributors Bobby Dean, Streeting highlighted how families have often felt abandoned, ignored, and damaged by the health services they are supposed to rely on. He also took note to recognise the importance of mental health support for mothers and families on the ward. As well as the national investigation, Streeting also noted work undertaken by Tommy’s into a ‘graded model of care’ for miscarriage including in bereavement support, health advice and risk assessments.

In October, Streeting also met with celebrity Vicky Pattison who has been a strong campaigner against medical misogyny following her experiences being diagnosed with Premenstrual Dysphoric Disorder (PMDD). Streeting committed to involving Pattison in the upcoming Women’s Health Strategy and including medical misogyny as a fundamental aspect. With this coming alongside an announcement that menopause will be included in routine NHS Health Checks, and the confirmation that the Women’s Health Strategy will be published next year, the Department for Health and Social Care has used recent weeks as a ‘policy blitz’ for their mission to remedy women’s health care and health disparities more widely.

In total, the last month has shown us that even in the philanthropic nature of healthcare, cash is king. Recent reports running up to the Budget speculate that tax increases are likely in order to safeguard the £53bn of new funding for the NHS. If it wasn’t clear from commitments set out in the Spending Review, the Spring Statement and the last Autumn Budget, the NHS, and cutting its waiting lists, is a boundless priority. Nevertheless, Streeting will have to tackle the clamour for more funding from the different prongs of the healthcare sector. Most prominently, the strikes remain a threat to both his political credibility and public sector productivity.