Health Foundation submission to the Spending Review 2025

The challenge

The government has bold ambitions for health and care. They have promised to recover services – particularly elective care performance – and ‘transform’ the NHS to make it ‘fit for the future’. A forthcoming 10-Year Health Plan is expected to spell out three shifts the NHS will deliver towards community, prevention and digital care. 

Yet the challenges facing health and care are huge. The health of the working-age population was already deteriorating prior to the pandemic, and now a fifth of working-age people report a work-limiting health condition. Improvements in life expectancy have stalled, and there are large inequalities in health within and between regions. 

We project that by 2040, the number of people living with major illness in Englandwill grow by more than a third to almost 1 in 5 (9.3 million people). Of these, 3.7 million will be working age (20–69 years), and 80% of the increase in working-age illness will be concentrated in the most deprived areas. 

A growing number of people who need health care often struggle to get appointments with GPs, and face long waits for both routine hospital treatment and emergency care. The pressures on NHS services pre-date the pandemic, but COVID-19 amplified them. Cuts to public health budgets and political failure to reform adult social care have weakened services that prevent ill health and support older people and disabled people to remain well and independent. 

Our submission

In our submission (finalised in February 2025), we presented evidence on the investment needed in the following areas:

• the public health grant
• adult social care
• the NHS 

Recognising the broader scope of improving health and the interactions between health and the labour market, we also put forward ideas on how to support healthier working lives. We also offer suggestions for how the spending review process could be reformed to support investment in prevention over the long term.