Nurses say levelling up is ‘lip service’ if lessons aren't learnt from Covid health inequalities

Healthcare workers and local authorities have hit out at the government for failing to learn from the pandemic and address health inequality in the Budget.

Rishi Sunak announced that health and social care spending would be brought back up to 2010 levels after a decade of austerity and cuts enforced by his own party.

But the Royal College of Nursing (RCN) said the Budget did not address the crisis at the heart of the healthcare emergency – a staffing shortage which experts say is largely down to low pay – with people in deprived areas set to be hardest hit to access the treatment they need.

“Despite lip service to levelling up, the chancellor has ducked the opportunity to address health inequality and invest in the country’s nursing staff as a means of investing in patient safety,” said Pat Cullen, general secretary and chief executive for the RCN.

“He failed to address [nurses’] pay and again kicked the can down the road by failing to give any commitment to a funded strategy for England to address the tens of thousands of vacant nurse jobs in health and care,” she added. 

Ministers have promised nurses a three per cent pay rise, well below the 12.5 per cent campaigned for by the RCN and less than inflation, which the Bank of England said could reach as high as five per cent. The average salary for an experienced nurse is currently £31,534, more than £6,000 less than if it had kept up with inflation since 2010.

Meanwhile healthcare staff are still feeling the impact of the pandemic, when their hours soared and they were often faced with more patients than they had beds, particularly in deprived parts of the country. An average of seven health care assistants quit their jobs every month at University Hospitals Coventry and the Warwickshire NHS Trust.

At St George’s University Hospitals Trust in south London, which runs one of the biggest hospitals in the country in St George’s, more than 55% of new starters leave within the first two years.

The quality of care given to patients is “paying a heavy price, as is our workforce,” Cullen said. The chancellor promised 40 new hospitals and 50,000 new nurses in his Budget statement, but gave no indication of how this will be achieved or if they will be targeted at deprived areas.

“Announcements on new hospitals and clinics raise patient expectations but without investment in the nursing workforce waiting lists will continue to grow,” the RCN chief executive added. “Patient safety should be the primary concern of every politician.”

Earlier this year, University of Cambridge researchers found a strong link between poverty and poorer healthcare provision. There are fewer full time doctors and nurses in the UK’s most deprived areas compared to more affluent areas, they said, a gap widening over time and contributing to the worse health outcomes of disadvantaged people.

The UK’s health inequality was laid bare during the Covid-19 crisis, when people on low incomes were more likely to experience severe illness or death with the virus.  The effect was particularly stark in Black and minority ethnic communities where the combination of low incomes and prejudice in the healthcare system resulted in death rates being significantly higher than for white people, NHS England research said. Bangladeshi people were hardest hit at between four and five times more likely to die with Covid-19 than the white population.

Around 83 per cent of Brits believe the healthcare system is overstretched, according to IPSOS Mori polling published this week, the highest of any country surveyed.

Speaking in the House of Commons, Sunak reminded MPs of Boris Johnson’s health and social care levy, the 1.25 percentage point national insurance rise scheduled for April.

But the government previously indicated this cash would go towards helping the NHS recover after the pandemic, with vague plans to reform social care in a few years.

It provided little reassurance to local authorities which have faced a decade of cuts and struggled to support communities through repeated lockdowns.

“Social care has been on the frontline throughout the pandemic and it is disappointing that no additional funding to address existing pressures on care and support have been provided in the spending review,” said Councillor David Fothergill, chairman of the Local Government Association’s (LGA) community wellbeing board.

He emphasised the need for long-term funding to improve services and support unpaid carers. Nearly all cuts made to social care during the Conservatives’ decade of austerity were made in the poorest parts of England, according to a New Policy Institute study.

After a report by MPs showed a dearth of cash for local dementia support, the LGA said future demand on social care services as the population ages will put even pressure on councils and carers.

“The number of older people living with dementia in England will increase to around 1.35 million by 2040, and many of these will require care and support from councils,” Fothergill added.