Shamefully, the autumn statement said nothing about social care | Jennifer Dixon and Anita Charlesworth

The chancellor’s autumn statement was met with incredulity and dismay by many in health and social care. Incredulity because the unusually extensive analysis and briefing on the state of the NHS and social services was so brazenly ignored, and this when the NHS is top of the list of issues the public holds dear. Dismay because of the likely consequences for the very groups in society that, ironically, the PM has pledged to help. Why did this happen?

Politicians of all stripes, patient and community groups, thinktanks, local authority leaders and many more express disbelief at the outcome. Does “project fact” no longer work? Are we in a “post-truth” world? Or is this short-termism by the government writ large?

Let’s look again at a few facts. Social care is at a tipping point. So says the Care Quality Commission, which should know, given it inspects all 17,000 social care providers in England.

Spending by local authorities on older people’s care has fallen by almost 10% in the first half of this decade. The number of older people receiving care has fallen by more than 400,000 – one in four fewer people getting help with basic needs. Family, neighbours and friends pick up the pieces and some older people pay privately. But increasing numbers of the poorest have no one to turn to. This growing gap has a human cost, but it’s also affecting the NHS.

Anyone using or working in the NHS can see that hospitals are full, operating at unsustainable capacity levels. There is a growing number of older people in hospital, medically fit to leave but unable to because of a lack of care in the community. The number of patients waiting in hospital for care packages to be put in place has risen by more than 40% in the past year alone. Other older people are in hospital when their condition could have been prevented by better support.

If the NHS was awash with money, this might be inefficient but manageable, but it isn’t. The NHS is receiving almost no increase in funding for 2018/19 and 19/20, despite growing demand and widespread deficits in hospitals. Increasing waiting times for care are the predictable result.

Meanwhile, the government continues to claim that the NHS is receiving an extra £10bn between 2014/15 and 2020/21, despite a direct challenge from the chair of the health select committee and a warning from the UK Statistics Authority. It makes this inflated claim based on a definition of “NHS” different to that used by all previous governments.

Extra funds were promised for social care from last year’s spending review, but too little and too late. Many working in social care are on the lowest wages. The national living wage will rise to £7.50 from April 2017 – welcome for the workforce, but a further cost pressure. This, coupled with rising demand from an ageing population, means social services across England face a £2.4bn funding gap next year.

Local authorities are running out of options – they have cut providers’ margins to the bone and many are walking away from contracts. Almost everyone currently receiving local authority-funded social care has been assessed as high need, so withdrawing services will bite especially hard. Who will hurt most? The poorest. The “just about managing” will “just not manage”.

With lower growth forecasts, extent of debt and the disruptive uncertainty of the vote for Brexit, room for extra public sector funding is limited. One option is to look again at the triple lock that ensures that state pensions increase by inflation, average earnings or a minimum of 2.5% a year. The triple lock has helped reduce pensioner poverty. Since 2008, the average income of those over retirement age has risen by 11% and the number of pensioners in poverty has fallen. But money alone doesn’t guarantee a dignified old age. For the most vulnerable old people, cuts to social care have left them without help with basic needs. There is scope for the chancellor to reform the triple lock before the 2017 budget to redistribute funds by boosting social care.

The referendum has shown that the active ingredient to prompting the political class to address a thorny issue is less about forensic analysis – “project fact” – than the mobilisation of public rage. It is worth pondering why this hasn’t yet materialised for the old and vulnerable.

So much for “a country that works for everyone”. This looks more like short-termist business as usual.

Dr Jennifer Dixon is chief executive, the Health Foundation. Anita Charlesworth is director of research and economics, the Health Foundation

Shamefully, the autumn statement said nothing about social care | Jennifer Dixon and Anita Charlesworth

London and the chancellor"s 2016 autumn statement

Look at it this way: UK economic growth is slowing, public borrowing will be higher than expected and the government no longer thinks it can balance the budget by 2020. Much of this is down to Brexit. Good old Boris. We’ve got our country back. Now we are free to scavenge for consolations from an autumn statement that seeks to limit the damage done by the referendum outcome, including in resilient London, the Remain City on which Leave Nation may depend more heavily than ever in the worrying years to come.

Chancellor Philip Hammond remarked that “for too long, economic growth in our country has been too concentrated in London and the south-east”. True, but that is also what you would say to a British euroscepticism that often goes hand-in-hand with hostility towards the capital. And though Hammond gave London’s mayor, its boroughs and its politicians of almost every type nothing like the transformative devolution package they desire, he did do some things to suggest that the government grasps that it cannot afford to ignore the capital’s pleas for more autonomy. He also observed that it is “one of the highest productivity cities in the world”, with Britain’s other big urban centres lagging far behind.

Sadiq Khan has been fairly positive about what Hammond announced, no doubt partly sincerely but also very mindful that his City Hall looks like having to keep on doing business with Conservative governments for at least as long as Jeremy Corbyn leads the Labour Party. He offered the glass-half-full view that the chancellor’s measures are “the first steps towards a major devolution deal for the capital”. In her own words, so did London Councils chair Claire Kober. We’ll see.

Top of the mayor’s thank you list for now is the £3.15bn the Greater London Authority will receive to help start the building of over 90,000 “affordable” homes by financial year 2020-21. As a single sum, this is the largest yet devolved to a London mayor, though the headline figure is slightly misleading in that it partly confirms funds already agreed as well as including an additional settlement for the future, covering the rest of Khan’s mayoral term.

Essentially, City Hall’s share of national spending on housing has been renegotiated and, in all, the capital has now got over £2bn more heading its way than it had before. It’s what the mayor was hoping for, and gives Khan and his team not only more cash but also – thanks to their new best friend, housing and London minister Gavin Barwell – greater flexibility to fund a range of what the mayor describes as “new homes for low cost rent, London Living Rent and shared ownership”. But hear the silence where even Boris Johnson once called for councils to be given more leeway to borrow to build for social rent. A lost cause, for now, it seems.

Hammond has also said he will devolve the adult education budget to London government from 2019-20, something else London politicians of more than one party have been in favour of for some time. The same goes for the transfer of the budget for the work and health programme – forthcoming successor to the plain old work programme – to London subject to “meeting certain conditions” (the same arrangement has been made for Greater Manchester, by the way). This should enable London’s boroughs to better help the 19,000 hard-up households to be pinched by the benefit cap. Whitehall, though, is holding on to the money for 16-18 year old skills training. London would like that too.

Khan has also welcomed further investment – to the tune of £492m to London and the south-east combined – in the London local enterprise panel, through which the mayor, businesses, the boroughs and Transport for London (TfL) collaborate on facilitating employment and growth and he expressed approval for a £1bn nationwide fund for digital infrastructure. Like Shelter’s Kate Webb, he was pleased by the abolition of letting agency fees (and I gather that City Hall is considering what that means for the mayor’s own, planned not-for-profit lettings agency). But he’s expressed disappointment that nothing was done to make childcare in London more affordable and that control over south London suburban rail is not to be handed down to TfL, though in the latter case he might not be much surprised.

Crossrail 2? Nothing doing. Hammond put Birmingham and the “Northern Powerhouse” first, but at least invited capital to produce its business case, which the London Chamber of Commerce and Industry says it is pleased about. Nothing much for London’s GPs and patients either, according to Michelle Drage of their representative body, which says that 35 practices have closed in the capital in the past 12 months and 45 since the last general election. Add to that the complete absence of help across the UK for NHS and social care services as a whole and the outlook for London as it wrestles with the latest reform programme has not been brightened. Meanwhile, local government in general continues to be savaged by cuts. Devolution is good. Pity it sometimes looks like the only way London can make the best of a bad national job.

London and the chancellor"s 2016 autumn statement

Labour pours scorn over autumn statement for ignoring sick and old

John McDonnell accused the chancellor of failing the sick and elderly after his autumn statement gave no additional money to the NHS or social care, despite warnings from the opposition party that both are at a tipping point.

The shadow chancellor said he feared a crisis in funding and care over this Christmas, after Hammond offered £23bn for infrastructure but no additional help for health services.

“Tonight, many elderly people will remain trapped in their homes, isolated, and lacking the care they need because of continuing cuts to funding,” McDonnell told the Commons in his response to the autumn statement. “You can’t cut social care without hitting the NHS …

“Across the country, hospitals are facing losing their A&Es, losing their maternity units, losing their specialist units. This Tory government is failing patients and failing dedicated NHS staff.

“It is the first time healthcare spending per head has declined since the NHS was created.”

Hammond mentioned the NHS in his autumn statement speech once to confirm the government’s commitment to spending an extra £10bn a year by the end of this parliament. There was no mention of social care and no additional money for either, despite warnings that shortages in funding are pushing hospitals to a tipping point.

In his response, McDonnell poured scorn on the small scale of measures to help families that are “just about managing” and highlighting a raft of struggling public services.

But it was Hammond’s failure to mention social care that caused the biggest response amongst Labour. Andy Burnham, the Labour former health secretary, said it was astonishing that Hammond could prioritise funding for new grammar schools over properly funding social care.

“Quite frankly, it is unbelievable that the chancellor could find no mention for social care today [after] six years of cuts of social care have left a record number of older people in hospital and the NHS on the brink,” he said.

Luciana Berger, the former shadow health minister, said there was mention in the 72-page autumn statement document that accompanied Hammond’s speech to the Commons of the words NHS, public health, social care, or mental health.

“The chancellor cannot ignore the fact our health and social care services are in crisis facing massive, massive deficits. Surely the many economists in his own department will have told him it is economically illiterate to ignore the massive decrease in people receiving social care in the community and the cuts to NHS and staff training. Why was the NHS missing from his autumn statement today?” she said.

Sarah Wollaston, the Conservative chair of the Commons health committee, said she wanted to get away with a divisive debate on social care and called for a cross-party consensus on solving the problem.

Social care is in crisis, says the Local Government Association. Photograph: Alamy Stock Photo

Wollaston also said she was “disappointed” that extra funding has not been brought forward at the autumn statement, although she welcomed the signals that this is now under consideration.

During the debate, Hammond criticised Labour MPs for being “fond of talking about cuts to social care budgets” when local councils, not central government, are in charge of managing their own funding.

“What we’ve done is created a ‘Better care fund’ that by the end of this parliament will be delivering a £.15bn a year into social care and allowed local authorities to raise a social care precept that by the end of this parliament will be delivering an extra £2bn a year,” he said.

“That is £3.5bn a year of additional funding into the system. What I would accept is there is an issue that local authorities are saying about the profiling, about how this large amount of money ramps up. It’s an issue we are aware of and are discussing with them.”

He later dismissed the idea that there was any “crisis or looming chaos”.

Izzi Seccombe, of the Local Government Association and Tory leader of Warwickshire county council was also critical. “Councils, care providers, charities and the NHS have all called on the government to use the autumn statement to properly fund adult social care,” she said.

“The government’s failure to act today means social care remains in crisis, councils and the NHS continue to be pushed to the financial brink and face the prospect of more care providers leaving the publicly-funded market or ceasing trading.

“Tragically, the human cost of this will be elderly and vulnerable people continuing to face an ever uncertain future where they might no longer receive the dignified care and support they deserve, such as help getting dressed or getting out and about, which is crucial to their independence and wellbeing.”

The criticisms were echoed by Dave Prentis, general secretary of Unison, who said the government had“chosen to ignore social care, preferring to look the other way as a growing number of elderly people are getting no care at all”.

“Scrimping on social care is a huge false economy. Older people are often stranded in hospitals, unable to go home, using beds needed by other patients. This turns up the heat on our already overstretched NHS, which has also been forgotten about today,” he said.

Prentis said the funding crisis would be made worse because of the increase in the minimum wage for care workers without an equal increase in overall funding.

“With no extra resources for local councils – whose budgets will be down £6.1bn by the end of the decade – the minimum wage increase means unbearable pressure on care budgets. The losers will be older people needing care and the dedicated workforce struggling to look after them,” he said.

Jonathan Ashworth, the shadow health secretary, told the Guardian’s politics weekly podcast: “Everyone has been pointing out that the social care sector is in crisis, on the verge of tipping points, lots of organisations including the chief executive of the NHS has been calling for extra investment in social care and he’s done absolutely nothing. Nowt. Zilch. It is unbelievable.”

Bronwen Maddox, director of the Institute for Government, added: “Despite emergency funding for prisons, today we saw little indication of how the chancellor will address the ticking time-bomb in other public services, like health and social care.”

Labour pours scorn over autumn statement for ignoring sick and old

John McDonnell says autumn statement "offers no hope" – video

John McDonnell describes the last six years of economic policy as an ‘abject failure’ in the House of Commons on Wednesday. The shadow minister accuses Philip Hammond of failing the sick and elderly after his autumn statement gave no additional money to the NHS or social care

John McDonnell says autumn statement "offers no hope" – video