This briefing calls on the government to recognise the immediate funding pressures facing the sector in 2018/19, which will see NHS funding growth fall to its lowest level in this parliament. The government must also act to close the growing funding gaps facing the health and care system, which are now having a clear impact on access to care.
- Continued austerity and rising demand for services are having a mounting impact on patient care. Waiting times are rising, and patient rights under the NHS Constitution are routinely breached throughout the year.
- We estimate total health spending in England will rise from £123.8 billion in 2017/18 to £128.4 billion by the end of this parliament in 2022/23.
- This is far below what is needed to maintain standards of care and meet rising demand. Based on projections from the Office for Budget Responsibility (OBR), we estimate that health spending would need to rise to approximately £153 billion by 2022/23.
- 2018/19 will be a crunch year for the NHS, with funding growth slowing to just 0.4 per cent, and a fall in spending on health care per person. We estimate NHS funding will be at least £4 billion lower than is needed in 2018/19.
- Even if the government met its manifesto commitments to increase NHS spending, this would not come close to meeting the projected funding gap of more than £20 billion by the end of this parliament. Any further pledges to increase NHS staff pay must also be fully funded, rather than being met from within the existing NHS funding settlement.
- Productivity in the NHS is improving by 1.7 per cent a year and is outperforming productivity in the wider economy. Even so, this will not be enough to bridge the gap between rising pressures and planned funding.
- The continued underinvestment in capital projects has left the NHS with deteriorating facilities and a £2.8 billion cost to address parts of the estate with high or significant maintenance risks. The government must set out a strategy to meet the recommendations in the Naylor review of NHS estate.
- Social care remains on the brink of crisis and, based on the latest available data, we estimate there will be a £2.5 billion funding gap by 2019/20. Unless additional funding is found, more people will be denied access to care and pressures will increase for service users, their families and carers.
- Short-term tactics to contain spending, such as holding down NHS staff pay and underinvesting in the NHS estate, have now more than run their course. After seven years of austerity the government must demonstrate that it has a credible medium-term strategy to better match the resources for the health and care service with the demands it faces.
- There is a need for a more strategic and independent assessment of the pressures facing services. A new independent body – modelled on the OBR – should be established to identify the long-term health care needs of the population and the staffing and funding required to meet these needs.
Nuffield Trust, The Health Foundation and The King's Fund (2017) The Autumn Budget: joint statement on health and social care. www.nuffieldtrust.org.uk/research/autumn-budget-2017