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Key points

  • 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 £123.8bn in 2017/18 to £128.4bn 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 £153bn by 2022/23. 

  • 2018/19 will be a crunch year for the NHS, with funding growth slowing to just 0.4%, and a fall in spending on health care per person. We estimate NHS funding will be at least £4bn 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 £20bn 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% 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 £2.8bn 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 £2.5bn 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.

The Health Foundation, Nuffield Trust and The King’s Fund are urging the government to address the critical state of health and social care in its forthcoming Autumn Budget.

The 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.

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