Some NHS services have faced real terms funding cuts, think tank says

Some NHS services have faced real terms day-to-day funding cuts in recent years, according to new analysis by a think tank.

Experts from the Nuffield Trust called for investment if more care is to be moved out of hospitals and into the community, but warned the next government has a “mountain to climb” to reverse the trend without detracting from funding pressures in acute care.

According to a report by the think tank, NHS expenditure in England increased on average by 3.1% in real terms in the last decade.

The analysis focused on funding for the likes of medicine and staff costs, rather than investment in buildings, equipment or IT, as this can fluctuate.

It claims that, when adjusted for economy-wide inflation, total funding for patient care increased by 20% in real terms from 2016/17 and 2022/23, an average of 3.1% a year.

However, it said how that growth has been shared between different services “varies quite radically”.

Nuffield Trust examined the funding for nine NHS services over the seven-year period.

It found three areas that experienced annual real-term cuts were public health (3.9%), dentistry (2.2%) and ophthalmic and pharmacy spend (2%).

The largest decrease in funding was felt by the local authority public health grant, which pays for the likes of sexual health and drug and alcohol services, according to the report.

The analysis found this fell by 21% in real terms between 2016/17 and 2022/23, bringing its share of funding down from 3.6% to 2.3%.

Sally Gainsbury, senior policy analyst at Nuffield Trust, said: “For over a decade, policymakers have rightly claimed that if the NHS is to be more than a sickness service, we need to develop and boost services that actively keep people out of hospital by managing long term conditions in their homes and preventing illness and chronic health deterioration.

“Only by investing in care in our communities – whether district nursing, health visiting, or speech and language therapy – can we really hope to address the many challenges presented by an ageing population and widening health inequalities.

“But our analysis reveals that the opposite is true when it comes to how much money is being invested in different forms of healthcare, with striking falls in needs-adjusted spending per person in key community and primary care services.”

Four areas had annual real terms increases, according to the report.

These were mental health (5.3%), ambulances (5.2%), acute services (4.4%) and GP primary care (3.3%).

Nuffield Trust claims that, as a result, these services have increased their share of total funding, the largest jump being in mental health from 8% in 2016/17 to a little over 9% in 2022/23.

Community services and prescribing remained flat, the think tank found.

Ms Gainsbury added: “Quite simply successive governments have cut back on the very services that are needed to support the ambition of moving care out of hospital.

“These trends are not an accident: when the chips are down, it’s the blue-light emergency services that swallow up what funding is available for healthcare in straitened times.

“Whoever forms the next government will have a mountain to climb to reverse this trend without detracting from the very real spending pressures in acute care.”