In a highly political pre-election Budget speech, Chancellor George Osborne was pretty quiet about the NHS - no doubt following Tory spin doctor Lynton Crosby’s advice.

Ed Miliband called it 'the secret plan to cut the NHS that dare not speak its name'.

There were, however, a few significant announcements of extra funding - but unfortunately, mostly likely to go not to the NHS, but rather to the growing number of companies and social enterprises feeding off it.

Voters' top concern is that the NHS is struggling, saddled as it is with a hugely costly market infrastucture and PFI debts, and old people spending hours in A&E and on hospital trolleys as a result.  

So if Osborne wants to be considered a possible successor to David Cameron, he has to be seen to do something bold, aside from the £2.7bn of not-really-enough and not-entirely-'new' money he announced in his autumn statement.

He pre-announced this 'something bold' a couple of weeks ago. As he reminded us today, rather than boost squeezed health and social care budgets, he’s thrown £6bn of them in the same pot together and will let the yet to be elected Manchester Mayor bear the responsibility for the results.

Osborne’s ‘Northern Powerhouse’ also includes £20m for the Health North initiative between teaching hospitals and universities to ‘promote innovation through analysis of data on the effectiveness of different drugs, treatments and health pathways’.

Good news on the face of it, but local hospital campaigners fear such moves are part of the over-centralisation of hospital provision, as Foundation Trusts are encouraged to innovate with commercial partners, but smaller NHS District General Hospitals are systematically squeezed of funds and downgraded to a lower tier of service. 

The Lib Dems have claimed as their contribution to the Budget, Osborne’s announcement of £1.25bn “funding for a major expansion of mental health services for children”, including £1bn “to start new access standards which will see over 110,000 more children cared for over the next parliament”. But it’s not quite clear who will be providing all this extra capacity. New Labour used 'access standards' (ie waiting lists) as the justification for handing elective operations over to Independent Treatment Centres, even though many pointed out they could have achieved the same results more cheaply within the NHS. It’s worth noting that a key Lib Dem party donor is private mental health provider Alpha, who have been heavily criticised by the inspectors for the treatment of young people in their facilities.

There’s also money to for the ‘Fit to Work’ programme (where ATOS replacement Maximus are also taking over renewing sick notes from GPs). This new cash will ‘support’ 40,000 people with mental health conditions back into work, by ‘offering’ them “Day 1 access to online Cognitive Behavioural Therapy (CBT)”. It will also be used to move ‘back to work’ therapists into job centres.

The budget also gives funding for various investigations. Could home improvements could keep people out of hospital? Could ‘social investment’ (ie, private finance) ‘support troubled individuals struggling with homelessness, addiction and mental health’. There will be also be a healthcare ‘enterprise zone’ (whatever that is) in Mersey Waters.

Most worrying for the NHS is what Osborne didn’t say. He didn’t promise to get rid of the private companies who are causing what Ed Miliband today rightly calls a 'gaping hole' in the NHS budget, of course. He didn’t promise to end the accounting trick attempting to massage borrowing and spending figures through the use of the Private Finance Initiative which yesterday drove the largest health trust in the country, Barts, into ‘special measures’.

Don’t worry though, because there’s a £40m for rolling out ‘Internet of Things technologies in healthcare and social care, and Smart Cities’. In normal language, that’s mostly medical ‘apps’ that claim to be able to replace your need for a hospital bed or a doctor with a phone…

And there’s a doubling of funding of support to UKTI, who help UK health and social care companies sell their services to China (most of the beneficiaries so far have been the private care home sector).

And - as the budget statement reminds us - Lord Carter (social care baron, architect of pathology privatisation, and director of various insurance companies) has been put in charge of an overarching cuts review, or as Osborne puts it, ‘undertaking action help the NHS achieve its efficiency aspiration’.

So that’s alright then!

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