In her Budget Statement the Chancellor of the Exchequer stated one of her aims was to cut waiting lists in the NHS.

According to a survey by the Times newspaper earlier this year it was estimated that there were on average 13,600 older people in hospital every day who did not need to be there awaiting social care, costing the NHS £2.9m per year. Therefore, one cannot resolve the problems of the NHS in isolation of social care.

The NHS and social care are in crisis and in need of radical reform, restructuring and cultural change to liberate the professionals from the constraining contract culture into an enabling leadership one. This requires the creation of whole task right sized multi-disciplinary teams aligned behind outcome able to plan, do and evaluate their own work which completes the learning cycle of constant improvement.

There is a wealth of empirical evidence into the social determinants of health which has demonstrated the correlation between income and demand upon the health services. One cannot go on throwing more money at the first aid camp at the bottom of the cliff without building a fence at the top. Treating the symptoms not the cause. A whole systems approach is required.

If the Chancellor really wanted to save money she would increase and not reduce the income of older people. Before the COVID19 pandemic killed 223,396 mainly older dependent people, 80% of the expenditure of health and social care was on older people. Britain has one of the lowest state pensions in the developed world with 2m older people living in poverty. To increase the state pension to lift all older people out of poverty would reduce demand upon the NHS and social care. It would also improve the quality of life of many and if older people did need long term care, applying the same financial assessment which has been in place since 1948 (when few people owned their own house) they would be able to pay more without having to take their house or capital into account which would also increase government revenue from inheritance tax.

The Chancellor’s budget speech was strong on rhetoric and good intentions. However, with the exception of the property tax, it was almost as though Rachel Reeves was unaware of the existence of the super-rich or the rising income inequality in our society which Morris Pearl, Chair of the Patriotic Millionaires and a former Managing Director at Black Rock believes “threatens everything we hold dear: our democracies, our planet and our broader society…..”.  Much of her address appeared to exclude the top 10% of earners.

In the Spring of 2025 Oxfam published its report “Takers not Makers” which suggested that global billionaire wealth had increased by £1.5trillion in 2024, a significant jump compared with the previous year. In contrast, according to the Office of National Statistics (ONS) the median household disposable income in the UK for the financial year ending 2023 was £34,500. This was a 2.5% decrease on the financial year ending 2022 when median household income was £35,100.

According to figures released by the Equality Trust, the UK is the sixth most unequal country by income of the 38 OECD countries. (Organisation for Economic Co-operation and Development). Many employees are paid the minimum wage to pay for this. The challenge is to address pay differentials within organisations so that everyone gets a fair day’s pay for a fair day’s work.

Unless Government tackles pay differentials, chasing inward investment in search of growth will make the rich richer and create low paid jobs for the masses as it has since the 1980s. The Equality Trust continues that “high income inequality weakens the social fabric and sense of cohesion between us. We are more likely to live, work and socialise in socially and economically segregated ways which can aid misunderstanding, resentment and undermine the sense of shared identity and purpose needed for a cohesive society”.