The NHS was a big winner at the Spending Review, with Chancellor Rachel Reeves announcing a \u2018record cash injection\u2019. Two hundred miles from the Commons in Manchester, NHS England Chief Executive Sir Jim Mackey, told healthcare leaders gathered at the NHS confederation\u2019s annual \u2018expo\u2019 that the government had \u2018done us a good turn\u2019.<\/p>\n
There will be a \u00a329 billion real-terms increase in day-to-day spending for the Department of Health and Social Care (DHSC), with its annual budget reaching \u00a3232 billion by 2028-29. The budget for the NHS in England alone will rise to \u00a3226 billion. Government spending on health and care will have doubled in a decade. The DHSC budget will eclipse the national income of Portugal and more than 40p in every government pound will be spent on the NHS.<\/p>\n
\nThe government has raised the\u00a0political\u00a0stakes for reform<\/p>\n<\/blockquote>\n
There was a strong sense of d\u00e9j\u00e0 vu listening to the Chancellor, as she reflected a growing fiscal orthodoxy. Greater NHS spending has been awarded owing to popular acceptance, whilst other areas of public spending are squeezed \u2013\u00a0including those which directly impact the \u2018wider determinants of health\u2019.<\/p>\n
There will be an increase of \u00a34 billion for adult social care (by 2028\/9, compared to 2025\/6), but care clearly remains the poor relation.\u00a0Little was mentioned of the life sciences or MedTech \u2013 genuine engines of economic growth \u2013 with reform announcements saved for a life sciences sector plan, due later this month.<\/p>\n
The government states that the purpose of the uplift is to enable the NHS to \u2018cut waiting lists, improve patient care and modernise services\u2019.\u00a0Much of the policy ambition \u2013 from seeking to improve the NHS App to hiring more GPs \u2013 is welcome and these measures have previously been\u00a0recommended by Policy Exchange<\/a>. But it is in no way certain these objectives will be realised.<\/p>\n
Internal modelling from the DHSC,\u00a0reported over the weekend, suggests the government\u2019s \u2018milestone\u2019 for waiting times \u2013 that 92 per cent of patients will start consultant-led treatment for elective care within 18 weeks of referral \u2013 is \u2018over-optimistic\u2019.\u00a0Policy Exchange estimate it would take another 155 months (or, to April 2038) to reach or exceed this target if the government were to continue on the performance trajectory we have seen since last year\u2019s general election.\u00a0<\/p>\n
Despite significant \u2018inputs\u2019 to the NHS budget and in staffing numbers, a significant gap in productivity compared to pre-pandemic years remains (-9 per cent comparing 2019\/20 to 2022\/23). \u00a0<\/p>\n
It is welcome that central departmental costs will be reduced, but the service has struggled to deliver the 2 per cent productivity improvement demanded in recent years. There is a risk that this investment simply disappears into thin air once more.\u00a0The \u00a322.6 billion uplift announced in last year\u2019s Autumn Statement has already been consumed by inflation and pensions.<\/p>\n
The DHSC will begin the Spending Review period \u00a31 billion \u2018in the red\u2019 and it has been suggested that the latest investment could be \u2018absorbed\u2019 by rising medicine prices and pay rises alone. A \u201950 per cent increase\u2019 in investment for \u2018NHS technology and digital transformation\u2019 is proposed, but a clear strategy and the mechanisms required to make good on this investment are still lacking. The recent recruitment of Axel Heitm\u00fcller as the PM\u2019s \u2018expert adviser\u2019 on health is a sign that there will be a welcome focus on how to\u00a0spread\u00a0innovation more effectively, given his prior experience.<\/p>\n
Whilst the capital budget will increase, it will remain flat in real terms, squeezing the resources required to \u2018modernise services\u2019 or to address a maintenance\u00a0backlog now over \u00a314 billion. The NHS will look to make greater use of private finance, but the announcement they will do so \u2013 rather curiously \u2013\u00a0was not made by the Chancellor. Instead it appeared on the NHS England\u00a0website<\/a>\u00a0later in the day, as part of Mackey\u2019s own \u2018100 day plan\u2019, which moots the introduction of an \u2018off\u2013balance sheet capital investment mechanism\u2019. The\u00a0form this will take has not yet been clarified.<\/p>\n
In boosting NHS spending once more, the government has raised the\u00a0political\u00a0stakes for reform. It is clear that they regard turning around a \u2018broken\u2019 service as being at the vanguard of meeting a more existential challenge: \u2018We must have a strong NHS \u2013 not\u2026an insurance-based system,\u2019 the Chancellor reflected yesterday, looking up at the MP for Clacton, Nigel Farage.<\/p>\n
But with the public again expected to back another massive rise in the NHS budget, with limited reckoning of the trade-offs in the near-term, their patience may be tested if improvement is not felt soon. The government\u2019s ten-year health plan must convince the public that they have the strategy in place, or it will look like the Chancellor is making a large, rather speculative investment.<\/p>\n","protected":false},"excerpt":{"rendered":"The NHS was a big winner at the Spending Review, with Chancellor Rachel Reeves announcing a \u2018record cash…\n","protected":false},"author":2,"featured_media":184420,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4316],"tags":[105,4348,16,15],"class_list":{"0":"post-184419","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-uk","11":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114683164940336888","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/184419","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=184419"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/184419\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/184420"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=184419"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=184419"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=184419"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}