The Autumn Statement sets out a budgetary plan that will take the UK back to the 1930's, as both the OBR and IFS analysis shows all too clearly. Between 2009-10 and 2019-20, spending on public services, administration and grants by central government is projected to fall from 21.2% to 12.6% of GDP and from £5,650 to £3,880 per head in 2014-15 prices. Around 40% of these cuts would have been delivered during this Parliament, with around 60% to come during the next.
It is inconceivable that the NHS in England can be exempted from cuts at this level because of the impact on other departments. The infographic below from C4 News illustrates this clearly.
The Chancellor's pre-election spending on the NHS and infrastructure brings a positive Barnett consequential of around £238m, of which £125m is attributable to the the additional NHS spending in England. For understandable political reasons, John Swinney has announced that this money will be allocated to NHS Scotland.
The NHS in Scotland could certainly use the extra cash. Today's exchanges at FMQ's highlighted the damning reports about NHS Grampian and Glasgow Royal Infirmary, and the recent Audit Scotland report showed a number of health boards have only hit their savings targets by making non-recurring savings or needed brokerage support.
Despite these pressures there should be a debate about how these immediate resources should be deployed because improving health is not entirely dependent on the NHS, even in the short term. For example, since April 2013, NHS boards have been working to the target that no patient should wait in hospital for more than 28 days from when they are clinically ready for discharge (reduced from 42 days previously). From April 2015, this is due to reduce further, to 14 days. However, boards are finding it difficult to meet the current target, with only three boards meeting this at the end of April 2014.
Local government is taking the brunt of cuts in Scotland, largely because the NHS budget is partially protected. Delayed discharges will not be tackled unless councils have the funding to address the social care system that is in real crisis. Just throwing all the available resources at the NHS won't cure that problem.
The scale of cuts set out in the Autumn Statement is truly horrendous - if anything the 'hyperbole' is too modest. However, there still needs to be a rational debate about how best to use the short term crumbs, even if that means some pretty tricky political choices.