Intended for healthcare professionals

Feature Data Briefing

This is what’s happening to NHS spending on public health

BMJ 2018; 363 doi: (Published 22 November 2018) Cite this as: BMJ 2018;363:k4869
  1. John Appleby, director of research and chief economist, Nuffield Trust, London, UK
  1. john.appleby{at}

Cuts to preventive health budgets have affected some local authority activities more than others, finds John Appleby

There was a time—perhaps hard to believe now—when the NHS was awash with money. At the turn of the century, with gross domestic product (GDP) growing at over 3% in real terms (also hard to believe now), decisions were taken to substantially boost spending on the NHS.

To put some analytical backbone into these political decisions the then chancellor, Gordon Brown, commissioned Derek Wanless to plot a long term course for NHS spending. The result, published in 2002,1 was three scenarios for future spending, differentiated by assumptions about NHS productivity and the state of the public’s health and health seeking behaviour. Higher productivity and a public supported to be fully engaged with its health meant a slower growth in NHS spending would be needed.

But the future turned out differently. Overall spending on the …

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