Medical training and public health budgets will be cut, Osborne confirms

BMJ 2015; 351 doi: (Published 26 November 2015) Cite this as: BMJ 2015;351:h6411
  1. Gareth Iacobucci
  1. 1The BMJ

The UK chancellor of the exchequer, George Osborne, has confirmed that budgets for medical training and public health will be cut, to help fund increases to the core NHS budget for the next five years.

The Treasury’s spending review outlines that the NHS in England will receive £10bn (€14bn; $15bn) more in real terms by 2020-21 than in 2014-15, with £6bn available by next year.1 This will raise NHS England’s budget to £101bn next year and to £120bn by 2020-21.

But, as experts forecasted ahead of the statement,2 the Department of Health’s wider budget, which pays for areas such as training, public health, and regulation, will be cut by 25%, which would currently amount to a loss of £1.5bn in funding a year.

Although the spending review was short on details of how these cuts would be implemented, it said that funding to local governments for public health would be cut by 3.9% a year on average over the next five years, while student grants for nurses and midwives will be abolished.

In return for the immediate funding boost to NHS England, the NHS will be expected to deliver £22bn of efficiency savings and seven day services in hospitals and general practice by 2020.

The review also announced an additional £600m to be invested in mental health services and a new “precept” to allow local authorities to raise council tax by 2% to invest solely in social care services. The Treasury said that the precept could raise £2bn a year by 2019-20 if fully used by local government and that this would enable social care spending to rise in real terms by the end of the parliament, when coupled with a £1.5bn increase to the integrated Better Care Fund by 2019-20.

Other big investments announced in the review include £1bn for new technologies in the NHS over the next five years and over £5bn in health research and development, including £250m for the 100 000 Genomes Project to introduce whole genome sequencing technology in the NHS.

The £4.7bn science budget will also be protected in real terms over the parliament.

But although the government was keen to emphasise the investment it was making, experts said that there could be a sting in the tail for the health and social care sectors.

On the 25% cut to the health department budget, the think tank the Nuffield Trust’s chief executive, Nigel Edwards, said, “Contrary to the impression given that this is simply a cut in the DH’s administrative spending, the Treasury’s figures show it actually represents a £1.5bn cut in a single year to budgets that include training for doctors and nurses and important preventive measures like stop smoking services and programmes to combat obesity.”

Edwards also questioned the validity of Osborne’s claims on social care: “Even by [the chancellor’s] own admission, [the precept] will only raise £2bn a year by the end of the parliament, and only if every local authority does it—whereas we already know that the funding gap for social care will be £2.9bn a year by then.”

John Appleby, chief economist at the think tank the King’s Fund, said that although the NHS had not fared as badly as other government departments, “it [the funding] falls a long way short of the new settlement needed to place the NHS and social care on a sustainable footing for the future.”

Appleby added, “It is clear that a large chunk of the additional funding for the NHS has been found through substantial cuts to other Department of Health budgets. The full details are not yet clear, but cutting the public health budget is a false economy, undermining the government’s commitments on prevention at a time when the need to improve public health is becoming increasingly urgent.”

Rob Webster, chief executive of the NHS Confederation, which represents most NHS trusts, said, “The commitment to frontload funding across the next two years gives the NHS a fighting chance to transform the way that care is delivered to patients.”

But he added, “The cut to public health in particular is hard to swallow considering the importance of investing now to keep people healthy and avoid building trouble for the future.”

In a joint statement the Royal College of Physicians’ president, Jane Dacre, and Royal College of Surgeons’ president, Clare Marx, welcomed the additional investment, but they added, “We await further detail about the future funding of health education, which is vital to deliver the next generation of healthcare staff, as the protection from budget cuts is removed.”


Cite this as: BMJ 2015;351:h6411


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