The Chancellor stated that the 2019 Spending Round 'turned the page on austerity', with an overall, real-terms increase in departmental spending of 4.1%. But with investment in the services and infrastructure needed for people to lead healthy lives at rock bottom, the question is whether the new spending is enough – and in the right places.

Some of the larger increases fall to services that manage acute societal needs – policing, criminal justice and social care. Those that create the long-term conditions that keep people healthy have fared less well.

As Resolution Foundation analysis has shown, the 2019 Spending Round has reversed only a third of the real-terms, per-head cuts in day-to-day spending since 2010. And those cuts have not been evenly distributed. While health care has been protected since 2010, other areas that are important for keeping people healthy have been cut significantly, and following the Chancellor’s Spending Round, still face overall reductions.

Next year, local government allocations (on a real-terms per capita basis) will still be 77% lower than in 2009/10, housing and communities spend 52% lower and education spend down by 11%.

The NHS has been a relative winner in public spending over the last decade, although funding growth has been at a much lower rate than demand and cost pressures.

But governments have chosen to prioritise health spending on front-line services over investment in key but less visible spending, such as training and developing the NHS workforce, on buildings, equipment and technology and crucially on support for services such as smoking cessation which keep people healthy.

Health spending pressures are rising in part due to the ageing of the population. This results in similar, if not greater, pressures on adult social care. But while the health budget grew over the decade, adult social care spending fell.

In this long read, we explore three key areas:

  1. the wider determinants of health (including the public health grant)
  2. adult social care
  3. The Department of Health and Social Care.

So: is the new spending enough – and is it in the right places to create the long-term conditions that keep people healthy?

Where does this leave the balance between NHS and adult social care spending?

And what does it tell us about the government's commitment to back The NHS Long Term Plan with the investment needed to improve care and deliver value for money?

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