RCR reacts to the Autumn 2024 Budget

On Wednesday (30 October 2024), the Chancellor of the Exchequer delivered the first Labour budget since March 2010. The Secretary of State for Health and Social Care was a clear winner of the negotiation process, securing an additional £22.6bn for day-to-day NHS spending, equivalent to a 4% real-terms rise, and a separate £3.1bn for capital investment across two years. 

The settlement is a step forward in terms of making the NHS ‘fit for the future’, with a clear target to cut waiting lists and deliver more appointments. There is much to be welcomed, with significant investment relative to years gone by, but the scale of the challenge facing the NHS remains enormous. How effective will this budget be in shifting the dial?

As part of the £22.6bn settlement, the budget reconfirmed that the NHS will be expected to deliver 40,000 more appointments a week to tackle waiting lists. This is likely to cover appointments for scans, cancer management and treatment, and even interventional radiology procedures. Bringing down NHS waiting lists is an obvious and necessary priority for the government. However, we must be realistic about the likely impact and feasibility of this policy. 

Additional appointments will certainly help patients access care sooner. But simply increasing the number of slots may not suffice if we lack the workforce and infrastructure to deliver them. We know that NHS staff across all specialties are facing high levels of stress and burnout. This is certainly true of our members; our latest census highlights that 100% of radiology   and cancer department leaders are concerned about stress, burnout, and wellbeing among their staff. Adding more shifts to an already overstretched workforce without a robust retention strategy will only add to the burden on doctors and may compromise the quality of patient care. 

The government must also consider any negative repercussion this may have on doctors’ pensions – clarification on this challenge was a notable omission from this year’s budget. If doctors are disincentivised from taking on additional shifts due to pension arrangements, it is highly likely that any additional shifts will not be taken up. 

The budget also commits £1.5bn to fund an expansion of diagnostic scanners, surgical hubs, and hospital beds.  Further detail on the breakdown of this funding is needed, so we can understand how much will be spent on diagnostics, versus surgical hubs and hospital beds. 

While not explicitly mentioned, we expect this allocation to encompass the originally penned ‘Fit for the Future’ fund, a recurring pot of money (of up to £250m per year) to double the number of CT and MRI scanners in the NHS. 

In recent media interviews, Wes Streeting has highlighted the potential of new AI-enabled scanners to produce better quality images and a higher volume of scans. However, to meaningfully bring down waiting lists and speed up diagnoses, we need to increase both the number of scans taken and the number of scans reported. New scanners can only help with one side of this equation – radiologists are responsible for delivering the other. 

Indeed, we have estimated that 100 AI-enabled MRI scanners alone would generate an extra 130,000 scans each year, requiring an additional 40.6 consultant radiologists to report.

The second iteration of the NHS Long-Term Workforce Plan must set out how the radiology workforce will be increased to meet the rising demand for diagnostics. With a 30% workforce shortfall (equivalent to 1,962 doctors) and a £276 million spend on managing excess reporting demand in 2023, NHS radiology services are already stretched to the limit. Without a focus on expanding workforce capacity, patients will have to wait longer for the results of their scan, delaying the start of treatment. 

As we set about engaging with the government, we’ll also seek clarification on whether this funding will cover the continued roll-out of Community Diagnostic Centres, especially in areas of high deprivation. CDCs help to build diagnostic capacity and reduce inequalities in access to scans, but we are faced with the same workforce challenges. Expanding physical capacity without consideration of the staffing implications will only lead to longer reporting turnaround times and higher staff turnover. 

The budget includes a £70m investment in Linac machines, something we’ve long advocated for, most recently in our pre-budget letter to the Chancellor. Replacing outdated radiotherapy equipment is a critical win for cancer patients and will support doctors in delivering timely, effective treatment. 

In our Spending Review submission, we calculated that £110.8 million would be needed to replace the 64 linear accelerator machines in NHS England that were over 10 years of age (as of 2017 – the most recent, robust data available). Therefore, we would like to understand how far the government projects this £70m will go, and whether further funding would be required in future. 

The budget also sets aside £1bn for spending on the NHS’s backlog of critical maintenance. This is very welcome, and will make a material difference for colleagues working in hospitals with urgent repair needs. However, it is a drop in the ocean in comparison to the total £13.8bn maintenance backlog the NHS faces. 

The budget includes a £2bn investment in technology and digital innovations for the NHS, to be spent on delivering electronic patient records, expanded functionality for the NHS App, and measures to save staff time. This investment is linked explicitly to a new productivity target of 2% from 2025. 

The NHS lags well behind other sectors in terms of digital maturity, with outdated IT creating unnecessary work and frustrating delays for staff. Addressing this issue will help clinicians to focus their attention on providing urgent clinical care. It would be beneficial if DHSC were to explain how this money will be spent, including whether it will be used to fund artificial intelligence projects that may streamline administrative processes and free up time for clinical care. 

We would also urge the government to take care when speaking about ‘productivity’. The quality of patient care should not be compromised. Real productivity gains are those that enable clinicians both to deliver more care per unit time and to improve the quality of that care. It is in this sense that we should truly measure the NHS’s productivity. 

As yet, we are still waiting for confirmation on whether the Chancellor’s announced rises to employer national insurance contributions (NICs) will apply to the public sector, including the NHS. 

Speculatively, it appears that the NHS will be protected from these costs. The Treasury has reportedly “set aside funding to protect the spending power of the public sector, including the NHS, from the direct impacts of these employer NICs change.” The Treasury will likely reimburse NHS departments, seemingly out of a separate pot to the £22bn committed to the health service in the budget. As a priority, the government should clarify this uncertainty and communicate any impact to NHS departments. 

Against such a challenging backdrop, it is undoubtedly good news that healthcare has been a clear ‘winner’ of this budget. Significant funding has been pledged to address the NHS’s shortage of capital and repair backlog, and sorting out diagnostics and cancer care has been identified as a key action to bring down waiting times. 

These are the right priorities for the government to have, yet the devil will be in the detail. We still have a number of questions to pose to the government to better understand whether this funding will address the day-to-day problems our members and their patients are facing. 

What is critical is that the government views this budget not as an end-result, but as the beginning of a longer-term programme to address the underlying causes of the NHS’s decline and to restore the health service to full fitness.