2019 Election: What next for NHS spending?

In a recent article, we looked at the impact of a no-deal Brexit on health and social care. Now that political attentions have turned from Brexit to the General Election (called for 12 December 2019), we consider the major political parties' election pledges for the health and social care sectors, in the context of the NHS Long Term Plan (LTP). With Manifestos due to be released over the next week, the first in our series focuses on what has been said by the major parties on front-line budgets and capital spending on healthcare infrastructure at time of writing.

Operating spending

With hospital waiting times recently reported as being at their worst ever level, front-line spending on the NHS is a key focus of the General Election. All of the major parties have pledged more funding to the NHS, with Labour now promising to spend an additional 3.9% per year – a global increase of £26 billion on day-to-day NHS spending by 2023-24. Labour would:

• increase the Department of Health and Social Care’s annual budget by an average of 4.3%, taking the Department's budget to £178 billion by 2023-24; and
• increase the overall budget for NHS England by an average of 4.3%, taking NHS England's annual budget to £154.9 billion by 2023-24.
• This is after the Prime Minister at the time, Theresa May, promised an equivalent increase of £20.8 billion in the July 2018 five-year funding settlement. These plans would see:
• Department of Health and Social Care’s annual budget reach £143.5 billion by 2023-24; and
• NHS England's annual budget reach £140.3 billion by 2023-24.

Capital spending

In July, the Financial Times reported that lack of capital spending on infrastructure in the NHS had "reached a crisis point". The Conservative government went on to pledge billions of pounds in capital investment into the NHS at their party conference, as part of a Health Infrastructure Plan (HIP). This came after (and in addition to) the 2019 Spending Round, where an additional £854 million funding was earmarked for the NHS.

The HIP set out a five-year programme of investment in health infrastructure, including a new hospital building programme. As part of the HIP:

• six hospital trusts will benefit from £2.7 billion of capital funding;
• 34 hospital trusts will receive £100 million in seed funding to begin the development of projects; and
• £200 million will be invested in replacing MRI and CT scanners and breast cancer screening equipment.

Labour have promised to increase NHS capital budgets by £15 billion over a parliamentary term. Their plans on capital funding have not been set out in detail, however in brief, their funding plan for the NHS sets out the following key priorities for investment:

• £2 billion for strategic mental health infrastructure to abolish dormitory wards, create new inpatient facilities and a new fleet of crisis ambulances;
• £2.5 billion to improve the primary care estate, in the context of an increasing focus on primary care to keep people out of acute hospitals; and
• increasing the number of CT and MRI scanners with £1.5 billion funding to improve cancer outcomes.

Conclusion

On the basis of the above figures, Labour's spend on the NHS operational budget would be 2.3% more than the Conservatives' plans. The Conservatives' capital investment offer for acute trusts formed a key part of their party conference and was set out in some detail earlier in the year. It is likely that the Labour manifesto will build upon its capital priorities set out above when it is released.

Whilst the Conservatives initially put a freeze on NHS capital spending last year, it is clear from the past few months' developments they now intend to invest heavily in NHS infrastructure. As expected, Labour have sought to better Conservative promises, with investment in both larger day-to-day budgets and on targeting promised capital spending on key areas of the LTP, such as mental health and primary care. 

It is clear that both major parties see the NHS as a priority following years of austerity and regardless of the winner of the December election, the NHS looks set to benefit from additional expenditure.