• The COVID-19 pandemic has had a profound impact on population health, the NHS and social care. 
  • We highlight four priority areas that the Spending Review 2021 must invest in to address the pandemic's legacy and build resilience in health and social care.

Note: All figures are for England only. All growth rates are in real terms and absolute numbers are in 2021/22 prices (using the GDP deflator).

Public health grant

The pandemic has resulted in a range of risks to health, both immediate and longer-term. Within local authorities, the public health grant has a key role to play in improving health by funding vital services, such as smoking cessation, drug and alcohol services, children's health services and sexual health services, as well as supporting broader public health activities across local authorities and the NHS. 

To restore the public health grant to its historic real-term per capita value and accounting for future cost pressures and demand would require an additional £1.4bn a year (in 2021/22 prices) by 2024/25. Phasing this in represents an average growth rate in the public health grant of 14% a year for the next 3 years.

Read our latest public health grant analysis

Graphic showing buildings, people, bus and a tree.

Capital

The capital budget of the Department of Health and Social Care (DHSC) is used to finance long-term investments in the NHS in England. Capital investment plays a crucial role in delivering a safe, resilient and effective health care service.

As a minimum, the NHS capital budget would need to grow in line with current plans and then continue to increase in line with the wider NHS budget. The Department of Health and Social Care’s capital departmental expenditure limit (CDEL) would need to be more than £10bn in 2024/25, rising to around £12bn in 2030/31.

Read our latest funding projections

Graphic showing cogs with pound sign at centre

Workforce

The workforce is the most critical input for delivering health and care. Prior to the pandemic, vacancies were growing. Growth in demand for workforce over the coming decade is projected to be much higher than the last decade.

Action on every element of workforce supply is needed: training, attrition, recruitment (including overseas recruitment), and retention. The Health Education England (HEE) budget needs to keep pace with growth in the wider NHS budget. We estimate the HEE budget would need to rise to at least £5.5bn in 2024/25 and continue to increase to more than £6bn in 2030/31. This equates to growth of 3–4.1% a year in real terms between 2021/22 and 2024/25. 

Read our latest workforce projections

Graphic showing people with an NHS staff ID card.

Social care

Although recent reforms to how social care is paid for are welcome, they will not be enough to deliver the prime minister’s promise to ‘fix social care’.

Once funding for the cap on care costs is taken into account, we estimate that the government’s recent announcement provides at most around £1.5bn a year to 2024/25 – compared with the £2.5bn needed just to meet demand and the £9.3bn needed to meet demand and to sustain and improve the current system.

Read more about the social care funding gap

Graphic showing hands holding people, including a person using a wheelchair.

 

Download our infographic

Read our full submission

Consultation response

Health Foundation submission to the Autumn Budget and Spending Review 2021

Consultation response

In this submission, we highlight four key additional priorities for investment: the public health...

Explore related content

Chart

Why greater investment in the public health grant should be a priority

Chart

The public health grant has been cut by 24% on a real-terms per capita basis since 2015/16. We...

Press release

Health Foundation response to Spending Review 2021

27 October 2021
Press release

Welcome investment in public services but lack of NHS workforce plan, and insufficient funding for...

Report

Health and social care funding projections 2021

October 2021
Report

The REAL Centre sets out projections of the funding the NHS and social care system in England may...

REAL Centre

Discover

REAL Centre

Discover

The Health Foundation’s REAL Centre is here to support better long-term decision making in health...

REAL Centre

You might also like...

Event

Webinar: Making healthy decisions on urban development and planning

Event

Join us for the fourth and final webinar in this series sharing emerging findings from UKPRP-funded...

Register

Event

Webinar: After COP26 – what will it take to get the NHS to net zero?

Event

A panel discussion exploring how the NHS can achieve net zero – from an international, national and...

Register

Newsletter blog

Up to the challenge?

Newsletter blog

Hugh Alderwick provides an overview of the government’s plans for spending and reform across the NHS...

Kjell-bubble-diagramArtboard 101 copy

Get social

Join @UK_PRP on Monday 13 December to explore putting health at the heart of urban decision-making processes. Hear… https://t.co/2CuJgb1huo

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more