Where has the money for the NHS and schools gone?

[EmmaGrundyForPM]

I'm not an economist so please cam someone explain this in lay terms to me?

The NHS and schools need far more funding. Along with other public services. But why is this? Taxes have risen, some costs have gone down, and yet there's not as much funding as,say, 20 years ago.

I work in local government. We've had wage stagnation for at least 10 years. In real terms, my pay is about 20% less. That's the same in a lot of other public services. I appreciate that other costs, especially building ones, have gone up.

Given that, as far as I can see, taxes haven't gone down, why is there now far less money to pay for public services?

.... MP wage rises and their expenses.

Also covering their multitude of fuck ups.

In the case of the NHS certainly (might be similar for schools) it's not that the budget has gone down (in real terms, it's gone up), it's that demand has increased. With an increasingly aging population, plus modern medicine doing a better job at keeping people alive for longer with multiple serious health conditions that need ongoing treatment and support, plus expectations/needs increasing in some areas e.g. mental health support needs, basically in effect the NHS is always trying to do more and more for a budget that is only increasing based on inflation for the needs of about 15 years ago now. Add to that capital challenges like the need to either maintain aging hospital buildings or build new ones and buy new equipment, pay for new and expensive drugs, plus the fact that overheads are going up for the NHS like for everyone else (yes hospitals have to pay gas and electric bills too, bloody big ones usually) you can see why the system struggles.

It's not that it's "gone" anywhere per se, it's just that it's having to stretch much further.

There is a huge demand from adult care which we've never before experienced in history. There has been a severe lack of capital investment over the last few decades - in buildings, for example - meaning there is now a lot of critical structural works which are urgent and very expensive.

Our population is greater and in the main unhealthier, than it was 30 years ago. We live longer. More people, living longer, with unhealthier lifestyles - that's always going to be more expensive.

Schools are experiencing the same issue with capital investment (see: RAAC) and population growth. The number of children on free school meals is increasing. EHCPs and the number of children who require SEN provision is increasing.

And let's not forget the huge increase in utility costs we've seen in the last two years.

Same money, but not enough for what is needed.

Official population has gone up by around 10 million, in reality probably more like 20 million. Not many of that increase will be net-contributors to the funding pot.

Also Local Government here (waves).

As PP have me mentioned, demand has gone up. But also, funding has not kept up with that demand, nor has it kept up with inflation. This means that there is less money per person in real terms, even if the overall spend has gone up.

In Adult Social Care, we've seen a gradual increase in demand every year for at least 10 years, driven by an aging population who previously may have died from their ailments, but thanks to advances in medicine, are able to survive but with increasing complex social care needs. The increases in national minimum wage, energy costs etc all mean that care costs have increased significantly above inflation in recent years.

At the same time, central government funding as been reduced and despite unprecedented demand, the government have not increased funding for local government in the latest budget. Ironic, given who their core vote base are.

I found this about school funding and again it's a similar situation.

School Funding:

epi.org.uk/publications-and-research/current-estimates-of-school-funding-pressures/

"School funding pressures by 2024-2025

Between 2009–10 and 2019–20, spending per pupil in England fell by 9 per cent in real terms. The government set out additional funding in the 2019 spending round and 2021 spending review and said that this would restore spending per pupil back to 2010 levels in 2024-25 based on inflation measured by the GDP deflator.

IFS now estimate that costs faced by schools will increase faster than rates of funding, this includes the increased cost of teacher and support staff pay. They estimate an increase between 2019-20 and 2024-25 of around 20 per cent – above the expected growth in the GDP deflator – which will mean that per pupil funding will remain 3 per cent below the 2009-2010 level. The 2021 spending review set the core schools budget in 2024-25 at £56.8 billion, therefore 3 per cent represents a shortfall of around £1.8 billion. There is a significant risk that high inflation will lead to higher pay than expected in 2023-24 which will further raise funding pressures"

For schools, demand for SN has increased enormously. Anecdotally for me, it seems like 15% of pupils are now requiring extra support. It isn't sustainable financially to have 6 paid adults per 30dc.

With a SN child at primary 6 years ago the school was very supportive and not an academy and support was given where needed and the child thrived. Then secondary was an academy and no support given and la blocked EHCP repeatedly and then child had no support during lockdown so I couldn't work and after that child went back but school on 80% staff so no SN support to keep school open. SN kids go into crisis, academies answer is to say can't meet needs. LA blocks everything. Children go into crisis and health bill ends up many times what education support will ever have cost. The attitudes to SN kids have become horrendous like they are to be eradicated and they end up feeling worthless as that is how society treats them now. It means kids who could have had support and gone on to be high earners will have bleak futures. I how a change in government changes attitudes but seems people have already started blaming SN kids.

Yes demand has gone up for schools too (but is dropping off in year R)

but also my schools budget havent physically gone down each year. The per pupil funding has increased. But it hasn't kept up with inflation so each year we have to cut back to balance the books. Everything we pay for goes up by more than our funding goes up, so to give a balanced budget we reduce service.

So each year I have worked, teachers and support staff have been offered payrises. These have been low, much lower than inflation, but have been more than funding increase. You remember that teacher strike. They were pushing for it to be fully funded.

The teachers pension employer contribution has increased but the grant to cover it is less than the increase.

Energy bills are huge..

Other services cost more too, like cleaners, fire inspections, training costs, repairs to broken things, it infrastructure costs.

Paper costs went through the roof as well.

And more complex needs are supported in school which costs more too.

I'm also slighlty suspicious that some academy chains are taking a bigger top slice than needed to have some big paying director roles...

Everything is so much more expensive now.

The £100 that would have paid for 200 exercise books now may only pay for 100 etc

wages are significantly higher than 14 years ago. In 2010 it was around £6 per hour so £10 per hour was considered a good wage. Now it’s almost double- then add employers NI etc.

10 million immigrants in the past 30 years obviously explains a lot of this. Especially when they bring their extended families over. And of course the younger workers grow old themselves and become a burden on the system they haven’t paid much in to.

The UK has become a joke in 2nd and 3rd world countries which see how easy it is to abuse our healthcare system which was really designed for a different era of low immigration in the wake of WW2.

And a catch22 for LA’s regarding provision for pupils with SEND.

Conservative policy is that LA’s cannot open new schools.
LA’s can plan and build but these must be opened and run by an academy trust.
We have schools ready to build/open but no trust to take it on.

Meanwhile LA’s are having to find school places for children with SEND. They have a legal duty to do so.

Places are either:
~mainstream which incurrs larger staffing costs and sometimes transport costs
~independent/out of area specialist provision which incurr huge fees and transport costs

The cost of an independent school place can be a six figure sum, per child per year. This comes from the LA budget. Transport costs are additional and are a huge burden on LA’s ( increased fuel, staffing costs, lack of providers).

At a judicial review 96% of cases are awarded the independent provision.

As I said at the start a huge catch22.

Health again issues with privatisation of services plus having cancer there are almost no checks re reoccurrence and my cancer wasn't picked up until stage 3 partly due to shortage of GPs and then needed chemo. Took 4 months for a referral. And started treatment in 2021, still waiting in 2024 for an operation which will have 3 month recovery time. The delays mean people sometimes don't return to work especially with SN kids who are getting no education at school as well and there are lots of these kids where no education is being provided by the state at all. It's like a third world country for them.

Welfare and pensions are 40% of the budget and have massively increased
demand on NHS has increased
GDP per capita has not increased to make up for these other increases in costs

The SN special schools are often privately run and can be 60k or 80k a year so la block them as they have no budget and schools are all academies now so always claim they can't help the SN kids as it disadvantages the other 29. But this just shifts the issue to health and in some cases social care and means lots of SN parents cannot work, I was earning the equivalent of a six figure salary today and had to give that up.

Repercussions from covid times

It's gone on salaries and pensions, pure and simple. Everyone wanted teachers and medics to be better paid and that's where the money for other resources has gone.

I agree with PPs that public services are being put under unprecedented pressure by the ever rising demands being placed on them. People forget that the welfare state and NHS are relatively new concepts that were devised in a completely different age where the population demographic was completely different, modern medicine didn't keep so many sick people alive and SEN wasn't really acknowledged. The big question is can such systems survive under these new pressures?

I think there is an assumption that the tax payer must somehow fund education, health and social care for everyone to a reasonable standard but this is a radical idea in the context of the rest of human history and what many other countries still do. The idea of personal responsibility and supporting yourself has been completely eroded but I believe it will make a come back as we will all have to look at how we contribute more to the services we and our families use. I don't really see another way as we all can't keep adding to the burden on the state and thinking someone else (who?) must pay for it.

Govt debt has also gone up a lot so a lot going on interest, COVID partly to blame.

https://images.app.goo.gl/RV6mL7fHMK7otDGJ7

I think that privatisation hasn't helped. ( also think about all the money given to unsuitable private PPE firms during the pandemic) If your bottom line is to provide a dividend for shareholders then the quality and value for money of the goods and services you provide can be compromised.

I was due to have hip surgery some years ago. The kits for orthopedic surgery were sterilised privately off site. I turned up for the op and was prepped etc

One of the kits they sent had broken packaging so wasn't sterile. They sent to the firm for another kit to be delivered rapidly but when that arrived, the packaging was also damaged. My surgery was cancelled and I had to return another day.

This obviously also had knock on effects of delaying surgery for others, wasting surgery team time and operating theatre space as well as the impact on me!

That isn't my experience. My staff member, British born married his fiancee who move to Britain from Pakistan. (2016).

For this to happen he had to earn more than £28,000 per year, over a period of years to meet the legal requirements. He upped his hours with me, taking on a before and after school club role in addition to his full time school role, to meet the earnings threshold.

Once married, to come to the UK, his wife also had to secure a full time role, again to meet the earnings threshold. Although a well qualified graduate, she accepted a job on a production line in a factory in the first instance.

And people don't understand that teachers where stricking for a fully funded pay rise and will probably do so again this year as they totally understand that a pay rise is useless unless it's fully funded from central government as it takes away from their own departments budgets.

We have been having to deliver a science circulum on the same budget for the last 10 years. Bearing in mind the cost of everything we buy has gone up massively, so far we have somehow managed. Oddly covid helped as we had a year when we didn't need to order consumables. Many schools are now doing micrscale experiments to save on costs (I haven't managed to persuade our chemistry tech to do that yet). But we will go that way it's inevitable.

Everything costs more to run. Staffing, utilities, technology (schools in particular have to pay stupid money for pupil management software, homework apps, payment software), apprenticeship levy (what a waste of money!). Money spaffed on "consultants". Money wasted plugging gaps which should have been dealt with elsewhere (eg NHS paying for diet groups and prescription paracetamol, primary schools employing nursery nurses to sort out toileting, SALT for DC who just haven't been exposed to basic conversation, EAL support for families who are not recent arrivals) - when we expect organisations to replace basic parenting and normal life choices, we have to pay them to try to do so.

But the budget is the budget, if you use it all on salaries, sick pay and pensions you'll have less for consumables. You can't magic money out of thin air.

Isn’t there als9 an issue with repaying capital costs from the PFI from years ago?

@MigGirl why are schools funding everything tho, when I was in senior school we basically brought in everything stationary wise now they just require a pen. It's like the massive IT suites they invest in yet kids have laptops they could take in. The NHS problem isn't just budget it's staffing unless staff are paid fairly they will leave and they won't be able to recruit replacements. The elderly also add an increasing burden with social care.

I don't know what the answer is as I definitely don't want to pay more tax. Personally I would like to see less state involvement in day to day, schools being allowed to ask for "donations" off parents (to the point it socially expected) and the availability of assisted suicide which people can sign as a lasting power when mentally well.

NHS could make a fortune with top ups I.e for routine surgery a list that is free but is X long whilst a list that is say 2k but 6 months long. If you have a surgeon doing 5 elective procedures a day 3 come from the paid list and 2 from the other etc.