Intended for healthcare professionals


Public spending must improve health, not just healthcare

BMJ 2018; 363 doi: (Published 06 November 2018) Cite this as: BMJ 2018;363:k4673
  1. Karen Bloor, professor of health economics and policy1,
  2. Maria Goddard, professor of health economics2
  1. 1Department of Health Sciences University of York, York, UK
  2. 2Centre for Health Economics University of York, York, UK
  1. Correspondence to: K Bloor karen.bloor{at}

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 …

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