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Spending Round 2019

In advance of the 2019 Spending Round - in which budgets for Government departments are set for 2020/21 - we wrote to the Treasury to set out the areas in the health and social care sector which, we believed, should be prioritised for investment.

We also highlighted our displeasure at the scope of the Spending Round being curtailed from setting departmental budgets until 2022/23 to just 2020/21 and departmental capital budgets also being excluded from the review.

These actions undermine the ability of the NHS to implement the Long Term Plan, and particularly hamper efforts to address the current workforce crisis in the NHS through the People Plan.

The limited scope of this Spending Round is especially frustrating, as this decision has been motivated by a desire to 'clear the ground' ahead of Brexit.

As health is a devolved matter, the priorities identified in our submission are England-focussed. However, as a result of the Barnett formula, any increase in health funding in England will result in increased funding for the devolved nations.

As the priorities identified are also pressing in the devolved nations, we would expect these areas to be the focus of any additional funding for health in the devolved nations.

Priorities for investment

In our submission we have repeated our call for the Government's expenditure on health, in both revenue and capital budgets, to be brought in-line with the spending of other leading European countries, as a percentage of GDP. For example, Germany currently spends 11.2% of its GDP on health, which is significantly more than the 9.6% of GDP that the UK spends.

We have also repeated our calls for the pensions taxation crisis to be resolved through reforming pension taxation legislation. In addition, we have also called for the Government to address the pay erosion experienced by all doctors over the last decade through significant additional investment in the remuneration packages of doctors in 2020/21.

The specific investment priorities we have called for in 2020/21 are:

  • £1 billion of investment for the public health grant for 2020/21. Investing in public health is essential if the prevention aims of the Long Term Plan are to be adequately supported by public health
  • reversing the cuts to HEE's (Health Education England's) budget as, since 2013/14, its budget has experienced sustained real-terms cuts of over £1 billion. These cuts must be reversed in 2020/21 if HEE are to be able to take concerted action to address the current workforce crisis in the NHS
  • £3 billion of capital investment to address the £6 billion maintenance backlog that exists within NHS trusts, of which over £3 billion is considered to be of 'high' or 'significant' risk.

Read more in our letter to the Chancellor


Our response to the spending round

On 4 September 2019, the Government set out its departmental spending commitments for 2020/21. These commitments fell significantly short of addressing the priority areas we had identified in our submission to Government.

BMA council chair Chaand Nagpaul commented:"After years of underinvestment, the NHS has been left struggling to cope with year-round pressures, leaving patients suffering long waits and doctors and their colleagues with rock-bottom morale. Today represents another missed opportunity from the Government to turn this around."

Read our press release in response to the Spending Round announcement.

Download our summary of the key commitments for health and social care.