As my Twitter friend Christopher reminded me; it was JK Galbraith who said, "The purpose of economic forecasting is to make astrology look respectable..."
The Chancellor's changes in policy and new found philanthropy are based, largely, on forecasts that the economy will perform well; yield a higher tax-take and interest rates will remain low.
These factors will have the effect of making government borrowing cheaper, give him more cash to play with and a less steep trajectory for him to arrive at his fiscal targets. The OBR forecasts are here; Page 37.
Let's hope so!
Grudging, carping, nit-picking and moaning aside; the NHS hasn't done too badly in the Spending Review. On top of the �3.8bn there is this:
The DH has taken a 25% hit on its budget which threatens the future of the organisations it sponsors and funds. Tough, yes but we could all see that coming. How often have I said 'circle the waggons and if it ain't patient facing, forget it'. It's not rocket science and that is exactly what is going to happen.
What else?
Councils will be able to levy an hypothecated precept of 2% on their Council Tax bills to help pay for adult social care. If they all chose to do it, it could mean about �2bn. Right now the funding gap is about �2.9bn... so, they are not out of the woods. And, there is the little matter of the lag in getting the changes through their democracy and bureaucracy and starting to collect the cash. This is not instant money.
Social Care funding will be increased in real terms by the end of the Parliament.
The Better Care Fund gets the kiss of life with �1.5bn, to support integration between health and social care. It'll be interesting to see how much of that ends up with management consultancies and squandered on palaver. I guess it depends on how you define 'support integration'.
Mental health can expect �600m of extra cash; for talking therapies and crisis-care. This will be tapered-in, over the next 5 years. No instant windfall.
Nurse training bursaries are scrapped and student loans replace them. This was something else we saw coming. As much as there will be howls of protest, which I fully 'get', centrally funding nurse training places is choking off the numbers. Uni's could train many more nurses than they get funding for. For every one place the government funds, there are five applicants.
My back-of-the-fag-packet calculations tell me loan repayments will start at about �7.50pm. The forecast is an extra 10,000 training places will be created. Quite how Trusts will handle the placements is another matter but it is a better problem to have than scouring the world for nurses.
However, the average age of a training nurse is 28yrs and half of them have children. Mmm...
It's not a popular idea and we can expect the unions and others to protest. However, there is no more money, this is a practical step designed to produce more nurses. Bolton Uni and Lancashire Teaching Trust have a non-commissioned scheme underway and there were 650 applications for 25 places.
The 'paperless NHS' target has been shifted to 2020 and �1bn has been conjured for technology and an interoperable patient record system.
Is everybody happy? Probably not. Smoke and mirrors, fiddling, fudging, robbing Peter to pay Paul, too many strings, short-sighted, could have done this and that, wasted opportunity... I can hear it all.
But, we are where we are. In many respects Osbourne has shifted his position and the NHS has moved from precarious and perilous to risky and exposed.
The Vanguards will have to deliver and the 5YFV is really going to have to deliver. If the EU falls apart, the wars, terrorism and hot-spots impact the economy, all bets are off.
The work starts now. It seems to me we have to make the most of what we have; be nimble, innovative, open-minded and inventive. It's time for pioneering and novel. Time for the enablers, the empowerers and the facilitators.
Time to say to everyone and every organisation 'this is the only show in town... to keep the show on the road'. If you can't be helpful, if you can't be cooperative, if you can't show what you are doing is patient-facing essential... why are you here.
Start with the patient and work backwards... the money will go further.
