Incisive Health analysis of the October 2018 Budget  

As many expected, the Budget did not announce much that was ‘new’ for the NHS.

The big announcement on money was made back in June, in the form of £20 billion to support the forthcoming NHS plan. In advance of publication of the plan itself, the Budget unsurprisingly continued the process of the pre-commitment of the additional money (on top of the requirement to meet increasing demand and eliminate overspends).

First, we had the Prime Minister’s commitments on cancer at party conference, and today the Chancellor’s promises on mental health. These promises are welcome in themselves but difficult to judge in the absence of the other components of the plan.

What about those areas of spend outside the £20 billion commitment but which impact on the ability of the NHS to deliver over the next 10 years – social care; capital; public health; and medical and nursing education and training? We heard nothing on public health or education and training, but there were some interesting announcements on both social care and capital.

On social care, the long-promised green paper will be published shortly. In the meantime, a further £650 million was committed for 2019-20 on top of the £240 million already promised for this winter.  Although this amount falls well short of the local government ask, it is clearly welcome. Is it enough to provide short term stability?

Capital investment will be critical to any plan that truly aims to transform the NHS. The assumption has always been that this would be funded by a combination of public funding, private finance and disposals.

We heard nothing about the level of public capital funding – this must await next year’s Spending Review. But, one particular surprise was the announcement of the end of PFI – a promise from Philip Hammond that as Chancellor he would never sign a PFI or PF2 contract. What does this mean for the NHS? Will there be new public funding, or some other mechanism for accessing private finance?

The Budget gave us another piece of the jigsaw but the full picture will not start to emerge until we see the long term plan before Christmas, and even then there will still be big holes until the Spending Review provides the last of the missing pieces next summer.

As the NHS enters what could be a challenging winter, the Government will hope that it has allocated sufficient resources ahead of the money kicking in.