How has the autumn spending review affected medicine in the UK? As you can imagine, the left-wing can pick holes in what the government is doing. The effects of the spending review are undoubtedly regressive - in that they hit the poor harder than the rich, but they have to be taken in the context of the two budgets that have been presented this year, the first by Labour and the second by George Osborne. When the whole package is examined it can be seen to be progressive, with the rich picking up the bigger bill.
The spending review has hit welfare benefits hardest. The main targets have been housing benefits, which have meant that the poorly paid and unemployed - including outrageous examples of recent immigrants with very large families living in luxury pads in West London - are subsidized to live in central London, while ordinary workers have to commute for several hours every day. I can certainly see the need to subsidize low-paid cleaners and essential workers like nurses and teachers etc to be able to do their jobs, but if you are unemployed in central London, then you really have no intention of working and you could be as indolent in Hull or Middlesboro, where you can buy a street for the cost of a house in London, no matter what your emotional ties to London.
There is also good news for those who are caught in a poverty trap. The welfare reforms should mean that it is always more profitable to work than accept benefits. At the moment there are perverse incentives not to work. Furthermore an element of fairness is being introduced. No-one should receive more in benefits than the average family income. After all the taxpayer funds these benefits, and were I earning only a small amount, I should protest at my taxes paying for my neighbor to get out of bed at 11 am, sit on the sofa, watch the racing on his flat screen TV eating Cherios and drinking cheap cider.
This may all sound like Daily-Mail-speak, and perhaps there are some harder cases that need consideration, but everyone puts up anecdotes to support their case. The Welfare Minister has presented some statistics which demonstrate that much of the hoohah is just that.
Of course, other departments have been hit by the cuts, but the government claim to have ring fenced the schools budget (though not the Department of Education itself), the NHS and the International AID budget. From today's Lancet we read - Although the health budget will increase by £10 billion to a total of £114 billion over the next 4 years—equivalent to a 0·1% rise per year in real terms—in recent years health spending has risen annually by over 4% in real terms. Many factors could lead to increased health-care costs, including the ageing population, a rising prevalence of obesity, the price of new medicines, the promised cancer drugs fund of £200 million, and the £1 billion a year needed to support social care that overlaps with the NHS (for example, rehabilitation care). This will, in fact, lead to cuts within the NHS, but then, in my time in NHS management, it was taken for granted that every year we had to find 2% 'efficiency savings'. This generally meant that somebody's pet project could not be taken forward next year or that we had to admit that last year we had 'banked' money - for example by buying a year's X-ray film in advance and holding it in cold storage.
What of medical research? Again the Lancet is encouraging: The UK has a tradition of excellence in science and medicine—this year Robert Edwards was awarded a Nobel prize for medicine, and David Weatherall won a Lasker Award. The UK is also the most productive research nation per head in the G8, producing 14% of the most highly-cited papers and 9% of total research publications, despite making up just 1% of the world's population. The Government has listened to the scientific community's argument that continued investment in science is vital to the UK's future success, and over £700 million a year on research and development from the Department of Health will be protected in real terms. Also, the spending review promises a real-term increase in the Medical Research Council's budget. “It is vital that we retain a good science budget and invest in our science base”, said Prime Minister David Cameron. The research community must now ensure that it delivers on this vote of confidence.
What about aid? Again the Lancet has a comment: The amount that the UK's Department for International Development (DfID) spends on overseas aid is to rise from £7 billion to £11·5 billion over the next 4 years, and by 2013 the UK should meet its UN commitment to spend 0·7% of national income on overseas development. The money spent on countries in conflict will increase to £3·8 billion, with a larger proportion going to Afghanistan at the expense of peaceful but equally impoverished African nations
There will be some readjustment as to where the aid goes - Russia, China and Singapore do seem to be inappropriate targets. I am in no doubt that Afghanistan is one of the most dangerous places on earth, especially on the Pakistani border. Whether you call it aid or not, that is where the International community needs to be focusing its efforts.