The government has broken its pledges on NHS funding and is misleading the public about how much extra money it is actually putting into the health service, a committee of MPs has said.
In a highly critical report, the House of Commons health select committee accuses Jeremy Hunt and other ministers of giving the cash-strapped NHS “less than would appear to be the case from official pronouncements”.
The cross-party group of MPs refutes the health secretary’s persistent claim the government will have given the NHS in England an extra £8.4bn by 2020-21 compared with 2015-16. That was one of the Conservatives’ key pledges in last year’s general election campaign, and was repeated many times after that by David Cameron and George Osborne while they were still the prime minister and the chancellor.
It claims ministers have in effect performed a sleight of hand by cutting other parts of the Department of Health’s budget, such as public health and NHS staffing, in order to give NHS England itself a big increase in its budget. Critics have previously likened the strategy to “robbing Peter to pay Paul”.
“Whilst the NHS has been treated favourably compared to many other departments, the increase in health funding is less than was promised if assessed by the usual definitions,” said Sarah Wollaston, the Tory MP and ex-GP who chairs the committee.
The report’s analysis of last autumn’s spending review notes that the NHS has received modest budget increases in recent years while most other Whitehall departments have suffered real-terms cuts. But it says: “The funding allocated for the NHS in the spending review is less than would appear to be the case from official pronouncements. We are concerned that the shift in resources, especially from public health, health education, transformation and capital budgets will make it far more difficult to achieve the ambitions set out in the Forward View [the NHS’s own blueprint for how it should modernise by 2020 in order to remain sustainable].”
The report adds: “In our view, the funding announced in the spending review does not meet the government’s commitment to fund the Five Year Forward View.”
It highlights how the government has changed its definition of NHS spending to include just the money that goes to NHS England and exclude, for example, money for recruiting and training NHS staff. “Excluding these aspects of spending – which are being cut over the spending review period – is misleading, as these organisations play a vital role in providing frontline services to patients, reducing demand through prevention and in training the future workforce,” it states.
Total health spending, which until now was the accepted definition of NHS funding, will only rise by £4.5bn by 2020-21, according to the committee’s report.
Measures backed by Hunt and NHS England to try and arrest the service’s huge financial problems, such as holding down staff pay, capping what agency staff can be paid and cutting the money hospitals receive for treating patients, “are not sustainable ways” of achieving the £22bn of efficiency savings that NHS England chief executive Simon Stevens has promised to deliver by 2020-21, the MPs say.
They describe the scale of the funding challenge facing the NHS, which is midway through an austerity-driven decade of tiny budget rises, as “colossal”. NHS trusts in England overspent by £2.45bn in 2015-16 as they tried to reconcile rising demand with efficiency drives and increasing understaffing.
“We agree entirely with the committee’s findings, in particular that the spending review does not meet the government’s commitment to adequately fund the NHS Five Year Forward View, with cuts to public health and health education funding short-sighted, and social care pressures not fully addressed,” said Anita Charlesworth, director of research and economics at the Health Foundation thinktank. Brexit could leave the NHS facing a budget shortfall of as much as £28bn by 2030-31, she predicted.
Giving the Department of Health the promised £8bn would mean “training for nurses and doctors, and money to invest in buildings and equipment: budgets which provide crucial support to frontline services,” said Nigel Edwards, chief executive of the Nuffield Trust thinktank.
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