The Chancellor must not break his promise to give the NHS whatever it needs in this week’s spending review, the British Medical Association says, with more than £10bn extra needed just to tackle the growing backlog in care left in the wake of Covid-19.

Throughout the pandemic, routine services and elective care were put on hold to focus on Covid-19, with figures¹ showing:

• 14.6 million fewer outpatient attendances than expected in England, potentially costing £1.7 billion to work through;
• 2.2 million fewer total elective treatments, costing approximately £9 billion to work through.

As more elective treatments are cancelled during this second wave of the pandemic, the size and cost of this backlog is due to increase over the winter.

The Covid-19 pandemic has placed unprecedented pressure on our already stretched and underfunded NHS, public health and social care systems, and the BMA is calling for both a long-term increase in health spending and immediate investment to cope with the ongoing impact of Covid-19, including²:

• A recurrent annual real-terms increase in health spending of at least 4.1% – equating to a £9 billion rise compared to Government’s (pre-COVID-19) planned spending by 2023/24.
• At least £10.7 billion to tackle the backlog of elective care and outpatient appointments.
• A multi-year settlement for capital funding in the NHS, with at least £6.5bn to cover outstanding maintenance costs and £1bn for GP premises.
• Investment in the NHS workforce, their welfare and staff retention, including a fair pay settlement that both recognises the sacrifices of doctors fighting the pandemic on the front line and the huge debt the nation owes healthcare workers at this time, and a commitment to start addressing the real terms pay cut that doctors have experience since 2008.
• An increase of £1 billion to the public health grant, with additional investment year-on-year increasing to £4.5 billion by 2023/24.
• An extra £12.2bn for social care by 2023/24.

Dr Chaand Nagpaul, BMA council chair, said:

“In March, the Chancellor said the NHS would get whatever it needs – and it is vital that he does not break his promise now.

“Both the NHS and our public health services went into the pandemic underfunded, understaffed and overstretched – and without an urgent injection of resources and a bold long-term funding plan the Government is once again setting both up to fail; and in doing so failing patients, staff and the wider health of our nation.

“The Covid pandemic has shone a piercing light on what happens when a system already pushed to its limits by years of under-resourcing faces a new crisis. With no additional room for manoeuvre, wards were repurposed, staff were redeployed and millions of patients had care postponed as all but the most urgent services were cancelled – something we are unfortunately beginning to see happen again in this second wave.

“So not only do we desperately need urgent extra funding to tackle the second wave and the acute pressures it causes, but also billions more are needed to work through the huge backlog in care left by the first – as well as a long-term settlement that puts the NHS, public health and social care services on a sustainable footing for the future.

“Staff have worked tirelessly this year, going above and beyond, often putting their own health and safety at risk. They are exhausted and distressed from seeing such high levels of extreme illness and death. We know many are facing burnout, and a significant proportion are considering their future career options. To protect the health of everyone, we need to invest in looking after and retaining our expert healthcare and public health staff, prioritising welfare, working conditions and ensuring they’re properly rewarded for the vital work they do.

“The Chancellor this week has a golden opportunity to make good on his word, and begin to undo the damage wrought by the failure to invest in the nation’s health – none of us can afford for him to waste it.”

Ends

Notes to editors

The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

1. BMA analysis compares the number of elective procedures taking place between April to September 2019 and April to September 2020. For outpatients appointments, it compares April to September 2020 with the average for the same period the previous two years. Cost estimates for the difference calculated using the 2018/19 National Schedule of NHS Costs.
2. Read "BMA Spending Review priorities: a bold new settlement for the NHS". Read the BMA’s full submission to the Comprehensive Spending Review, submitted on 24 September, here.