119. Can Labour’s spending review really mend public services?
Dec 9, 2024
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In this insightful discussion, Paul Johnson, Director of the Institute for Fiscal Studies and a public finance expert, delves into Labour's spending review and its potential impact on public services. He evaluates whether Wes Streeting can realistically reform the NHS amid existing funding challenges. Johnson also highlights the shortcomings of data on the UK jobs market, raising concerns about economic policies. The dialogues explore systemic inefficiencies and the urgent need for innovative solutions to improve public service outcomes.
The upcoming spending review faces a tight budget cap that risks underfunding vital services outside the health sector.
Reform of the NHS under Labour may struggle to achieve meaningful improvements due to longstanding inefficiencies and rising demands.
Deep dives
Importance of the Upcoming Spending Review
The upcoming spending review is critical for determining the allocations of government funding from 2026 through the end of the current parliamentary term. This budget will decide the financial resources available for various sectors, particularly health and education, following a previous budget that significantly increased taxes and borrowing. The review will be particularly challenging as it sets a very tight spending cap, potentially leading to cuts in departments outside health. This situation is complicated further by the historical trend of the health service consuming a larger share of public spending, raising concerns about the impact on other vital services.
Challenges Facing the Health Service
Current increases in funding for the health service may not be sufficient to address the pressing issues it faces, as productivity has significantly declined relative to spending. The health service's share of public expenditure has grown, consuming over 40% of all public service spending, which limits available funds for other areas. Moreover, despite receiving significant financial support, the health service continues to struggle with rising waiting lists and inadequate outcomes for critical treatments such as cancer care. The concern revolves around whether the recent funding will lead to meaningful improvements or simply maintain the status quo.
Labour Market Dynamics and Employment Challenges
The labor market currently faces contradictions, with efforts to boost employment countered by increased costs and regulatory burdens for employers, especially in low-wage sectors. A significant rise in the national living wage, coupled with changes to employer national insurance contributions, particularly impacts organizations hiring low-paid workers. These shifts create apprehension among employers about hiring additional staff, prompting fears of a potential job market slowdown. Questions arise about the reliability of employment data, as current statistics are obscured by low response rates to surveys, leaving a gap in understanding the true scope of workforce participation.
Need for Reforms in Public Services
There is a pervasive call for reform across public services, yet achieving tangible results poses significant challenges. Critiques of existing services highlight inefficiencies and suggest that the current systems must adapt more effectively to changing demands. While the government has made pledges for reform, skepticism remains about the feasibility and impact of these changes, particularly within the health system. Historical examples of reform indicate that without a clear understanding of existing systems, efforts may result in confusion and disruption, rather than improvement.
Robert and Steph speak to Paul Johnson, Director of the Institute for Fiscal Studies, about whether Labour can fix our creaking public services in next years spending review, if it’s realistic that Wes Streeting will ‘reform’ the NHS and why vital data on the UK jobs market is so poor.