UK benefits bill will keep rising without NHS reform

Good morning. Well, that was embarrassing for all concerned. The government came perilously close to losing yesterday’s Commons vote on the welfare bill. (Embarrassing for me, as I thought it had made sufficient concessions.)

By lunchtime yesterday it was clear that the government could still really lose the vote.

Alan Campbell, the chief whip, warned the cabinet at noon that the vote could be lost, and, having got into so much difficulty by ignoring the chief whip over this issue, Keir Starmer wasn’t minded to make the same mistake twice. So over the course of a shambolic afternoon the government essentially abandoned all the big spending reductions in the bill: meaning that the £5bn of “savings” identified have all been undone. A total of 49 Labour MPs voted against the bill, along with 100 Tories, 70 Liberal Democrats and 12 independents.

The big picture problem here is that it is impossible to get a measure through if you don’t have any real intellectual justification for it. The government did not engage seriously with the policy area or the relevant stakeholders (not least Labour MPs). The outcome was a disaster, the echoes of which will be felt far into the future.

One neglected aspect is how “welfare costs and reform” link to “reform of the NHS and how it operates”, something Jonathan Eley writes on for us in today’s note. And plenty more to come on this I’m sure in our live Q&A on Labour tomorrow at 1pm. Pop your questions in the comments here and Robert Shrimsley, Miranda Green and I will tackle them.

The missing link

Yesterday, MPs voted on a package of measures intended to contain the surging cost of disability-related benefits. Tomorrow, they will hear about the 10-year plan to save the NHS. One of the most surprising facets of the benefit cuts debate to me has been the relative lack of linkage between these two issues.

Based on my family’s experience of chronic illness and growing disability over the past two decades, that link is both direct and significant. Millions more people are on health-related benefits because Britain’s health service keeps them sick.

Partly, this is of course down to challenges around funding and staffing. But it’s also because of the way the NHS is structured and managed — and without profound change here, the costs elsewhere will continue to pile up.

The NHS is not national, and nor is it truly a health service. It is organised largely around delivering acute care for discrete events or conditions — so if you break a leg, suffer a stroke or heart attack, develop cancer, or have a baby, it generally responds quite well.

With a few exceptions, it is relatively disinterested in prevention. And its approach to chronic disease seems to be either to ignore it, or to wait until it manifests itself in some acute way more suited to the NHS modus operandi.

My wife suffers from several overlapping chronic autoimmune conditions. They are mostly incurable, under-researched and episodic. That means there are occasional good days. But there are many more bad days when pain or exhaustion mean she can barely function. It would be nice for sufferers, and convenient for officialdom, if the good days could be scheduled to coincide with part-time work. But of course, they cannot.

Many chronic conditions such as multiple sclerosis, ME/CFS, fibromyalgia, thyroid problems, arthritis and Ehlers-Danlos syndrome present more frequently in women than men, affording opportunities for their symptoms to be variously dismissed as anxiety, hormones or the menopause. For rarer conditions the National Institute for Health and Care Excellence (Nice) doesn’t often offer any guidelines on treatment. In practice that usually means: no treatment.

What provision there was for managing such conditions shut down overnight in March 2020 and a lot of it has never reopened. There is now only one pain management centre in our NHS area, for instance — and it isn’t accepting new patients. The NHS doesn’t prescribe, let alone pay for, alternative therapies such as acupuncture, and Nice hasn’t approved some of the drugs that are used effectively (often off-label) in other countries.

That leaves sufferers with Dr Google, their families and a collection of Facebook groups for support while they navigate the NHS’s suffocating bureaucracy and hair-splitting demarcation, work around its dreadful IT, and harass different bits of it until they actually talk to each other.

Chronic illness eventually brought my wife’s three-decade career to a premature and distressing end. Tuesday’s vote is unlikely to change that, and Thursday’s announcement will probably come too late.

Now try this

Stephen here again. I had a marvellous afternoon at Kings Place this weekend, listening to music by Poulenc, Copland & Bernstein as part of the “Classical Pride” festival. You can listen to all the music on Kings Place’s website here, while there are still tickets for the festival’s remaining events here.

Top stories today

• How will it be paid for? | Rachel Reeves was given a grim reminder of the fragility of the public finances when the UK’s fiscal watchdog admitted yesterday that its forecasts have repeatedly been too optimistic. Any cuts to OBR forecasts ahead of Reeves’ autumn Budget would add to her mounting fiscal and political woes. The FT examines whether the chancellor will look to bend the fiscal rules to fund public investment and spending through higher borrowing.

• Sending the wrong signal | “Perhaps more important than . . . what it might mean for the government’s so-called ‘fiscal headroom’ is the potential impact on how this government’s fiscal credibility is perceived”, said the Institute for Fiscal Studies. As the IFS’s Ben Zaranko pointed out on Bluesky last week, “if markets think future spending plans are undeliverable and that government will end up spending and borrowing more, that will get priced in via higher gilt yields”.

• The morning after the night before | Cabinet minister Pat McFadden, out on the breakfast media rounds today, said the government would “stick to the tax promises we made in the manifesto”, ruling out an increase to National Insurance, income tax or VAT. “The case for welfare reform, for making sure people on disability benefit get the support they need, remains there” but stated “we will have to do this at a slower pace”.

• Also from the IFS | Ministers should ditch the pensions “triple lock” as part of a wider overhaul that is needed to prevent millions of private sector workers experiencing a sharp fall in living standards when they retire, research by the IFS and Aberdeen found.

• ‘Frustrated’ by Brussels | The EU is blocking Britain’s attempts to join a pan-European trade area to reduce post-Brexit supply chain challenges for UK goods exporters, according to officials on both sides.