Public spending must improve health, not just healthcare:A narrow focus on the NHS neglects the much wider determinants of health

Last week’s budget held few surprises for the NHS because the “star bunnies”1 had already been released from the chancellor’s hat by the prime minister, whose summer announcement included a £20.5bn (€23bn; $27bn) “70th birthday present” for the NHS.2 But, as many have noted, the extra funding committed by 2023 (3.4% a year) is relatively low compared with historical trends—average annual increases since 1948 have been around 3.7%3— and it follows a long period of very modest growth. When adjusted for need, NHS spending has risen by only 0.1% a year since 2009-10 in real terms,4 and the spending pledge is widely viewed to be only enough to get the basics back on track.5 Top line figures also ignore what is happening to different funding streams. Increases are directed at only one part of the healthcare system—NHS England—ignoring NHS infrastructure such as training, IT, and buildings, all of which are under increasing pressure, as well as spending in Wales, Scotland, and Northern Ireland. Despite the efforts of local authorities to protect social care spending, it has fallen by 1.5% a year between 2009-10 and 2016-17,4 and as the deputy chief executive of NHS Providers put it, “When social care is cut, the NHS bleeds."6