Worried how your organisation will cope with the coming real terms cut in its spending power? Well, don’t be. By the time you read this, it will already have survived its first year of it.
Assuming, that is, we can trust what the Department of Health’s accounts for 2009-10 tell us*.
Page 125, table 1, shows that in 2009-10 the NHS spent £100.2bn, excluding depreciation. An extra £1.63bn went on personal social services, but for a like for like comparison with the Treasury’s Budget book we need to exclude that. As usual, last week’s Budget updated the earlier estimates of the current year’s spending with the latest forecast outturn. That put NHS spending, excluding depreciation and excluding social services, at £98.4bn revenue and £4.5bn capital, down from the earlier estimate of £98.7bn and £5.1bn at the time of the October spending review.
The difference between the 2009-10 and the likely 2010-11 NHS spend is now just £2.7bn – a 2.7 per cent cash increase, at a time when GDP inflation (depending on which estimate you use) was chugging along at between 2.9 and 3.1 per cent. A belated welcome to austerity.
It is only fair to note 2009-10 was a bit of a bumper year, what with swine flu, the capital budget being fiscally stimulated and the DH actually being allowed to spend some £400m of its previously accumulated £1.7bn surplus.
The NHS is always underspending on capital, and it has grown used to not getting that back. But the shift in the revenue estimate between the spending review and budget is more interesting – down by £300m. That looks like the £300m of accumulated surplus the NHS was told in both the original and revised 2010-11 operating frameworks it should spend, which together with the £400m actually spent would have reduced the surplus to £1bn.
But that was before last October, when the Treasury cancelled the DH’s ability to cash in previous years’ underspends. The department insists it will continue to honour the £1.3bn in credit notes that sit with primary care trusts and strategic health authorities. But guess what?, its quarter three figures are anticipating that using these funds will not be necessary, and that the surplus will stay at £1.3bn.
*Following this column’s queries, the DH confirmed that one cannot believe what one reads in the DH accounts. It said the published figure for 2009-10 is wrong and actual spending was £99.45m; just getting the NHS nose over the real terms line. Where the unspent extra £750m is sitting is anyone’s guess.
Sally Gainsbury writes for the Financial Times.