Budgets and fiscal events

The UK’s major fiscal events, which includes Budgets, Spring and Autumn Statements, and Spending Reviews, are where the Chancellor sets out major policy announcements for tax and public spending policy. 
Location: England
Updated: Wednesday 29 November 2023
NHS Structure Article Illustration

Autumn statement 2023

Key points for members

Context

On 22nd November 2023, Chancellor Jeremy Hunt gave his Autumn Statement on the government’s economic policy for the next five years, and the OBR (Office of Budgetary Responsibility) published its forecasts of the economic outlook for the same period. You can read the statement in full here. This briefing sets out key details and highlights the implications of the government’s most recent decisions on tax and public spending for BMA members.

Summary

Heading into this fiscal statement, the Chancellor had more money to play with (so-called ‘fiscal headroom’) than had been projected at the March Budget 2023. That is largely because wages were higher than expected, resulting in increased tax revenue.

However, inflation was also persistently higher than had been projected. As such, planned budgets for departments, including the department of health, are no longer worth as much in real terms.

The Chancellor could have used the additional fiscal headroom to ensure departmental budgets were protected from inflation and other cost pressures – but he didn’t. This means there was no new health funding, despite the large deficits in the NHS’ finances due to higher than expected cost pressures – Nuffield Trust estimates a £1.7 billion overspend by NHS England by the end of this financial year, compared to available funding.

The majority of additional spending power available was used for tax cuts and welfare payments instead. The biggest areas of spending were:

  • National Insurance rates were reduced for employees and the self-employed,
  • Businesses can claim tax write-offs against certain forms of investment,
  • The state pension and main unemployment benefits were increased, and there were major reforms to the way people with long-term health conditions or disabled will be treated.

It is also worth noting that the Chancellor did not leave much leeway for additional spending. In general Chancellors try and keep some funding available in case of shocks or emergencies, but this Statement left very little available compared to recent historical fiscal events.

 

Key points for individual doctors

  • There will be cuts to personal National Insurance contributions, but since tax thresholds remain frozen, most taxpayers will still be worse off.
  • The triple lock on the state pension will be kept, but the annual allowance for non-state pensions was not uprated to account for inflation.
  • Thresholds for childcare support and child benefits were also not uprated (and haven’t been since they were introduced).

Key points for GP practices

  • The Statement had a stated focus on supporting businesses, particularly small businesses, but only some GP practices will benefit from the announced policies.
  • Smaller GP practices based in lower value properties will pay the same business rates as before, but those based at higher value properties will see their business rates increased.
  • Incorporated GP practices may be able to benefit from full expensing.
  • The increase of the National Living Wage may incur additional costs for GP practices employing minimum wage staff.

Key points for health services

  • No new funding was announced for health and care services, and the funding promised in the Spring Budget was not uprated in line with higher inflation than previously projected.
  • Pharmaceutical spending in the NHS is set to rise as caps on pricing will be raised.

Key points for population health

  • More needs to be done by government to protect and improve population health.
  • Whilst duty rates for tobacco will increase, alcohol duty will be frozen and gambling duties will remain frozen.
  • Plans to bring more people in ill health into work risk being counterproductive if they end up cutting off people from benefits when they need them.
  • The government also failed to announce additional support with the cost of living, at a time prices continue to rise and living standards are set to fall.
  • More needs to be done to address the climate crisis and protect the people from its dire consequences on their health and beyond.

Key points for healthcare innovation

  • The Autumn statement had a strong focus on fostering business and innovation.
  • Some of the support and funding announced will benefit research into health and healthcare innovation.

Download the full member briefing below.

Download member briefing PDF/484KB

 

 

Previous fiscal events

2023 Spring budget summary for members

This document provides a summary of the key takeaways from the  2023 Spring budget. set out by Chancellor Jeremy Hunt on 15 March 2023.

Key points for members:

  • The Chancellor committed to changes to pension tax thresholds after extensive BMA lobbying. The annual allowance threshold will increase by 50%, from £40,000 to £60,000, and the lifetime allowance threshold – previously set at £1 million – has been completely abolished.
  • No new announcements made on NHS pay including no funding commitments made to address pay restoration for doctors or other healthcare staff.
  • The Chancellor announced the extension of the 30 hours of free weekly childcare available to parents in England to cover children below the age of three and to eventually cover all children from the age of nine months.
  • Additional support with energy bills was also announced with the Energy Price Guarantee – set to end in April 2023 – to be extended for another 3 months to July, when both energy costs and usage are expected to fall. There was no extension to the EBRS (Energy Bill Relief Scheme) for businesses, putting significant pressure back onto businesses – such as General Practices – to manage risk.
2022 Autumn statement summary for members

This document provides a summary of the key takeaways from the Chancellor’s 2022 Autumn statement on 17 November 2022.

Key points for members:

  • The Department of Health and the NHS were promised £3.3 bn per year in additional funding for day-to-day spending, but when adjusted for inflation, the amount of money the NHS has next year is still less than what was promised previously, in the 2021 Spending Review.
  • The Chancellor committed to publish a workforce plan setting out independently verified numbers of doctors needed over the next 15 years.
  • Changes to personal tax policy will reduce the take home pay of all workers, including doctors.
  • Overall, the cost-of-living crisis and dire economic picture will increase poverty and impact health, increasing pressure on the health system.
2022 Spring statement summary for members

This document provides a summary of the key takeaways from the Chancellor’s 2022 Spring Statement on 23 March 2022.

Key findings on health and social care funding:

  • no increases or decreases to health spending
  • there was confirmation that the new health and care levy will go ahead (although the threshold at which you start to pay it will be raised)
  • the NHS efficiency target will double from 1.1 per cent to 2.2 per cent and this will include a review of Arm’s Length Bodies including NHS England and NHS Improvement.
2021 Autumn budget and spending review

Chancellor Rishi Sunak announced the Autumn budget and spending review to Parliament on 27 October. Our briefing covers the need to know aspects for doctors, the NHS, social care and public health and our analysis.

Resources

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