The Chancellor and prime minister have agreed the NHS should not have to foot the bill for knock-on pressures from rising demand for social care, senior sources told HSJ.

The commitment was agreed as part of the five-year NHS funding deal announced today, sources said.

The arragement includes a commitment that the health service “should not face additional pressures” because of demands from social care, one very senior source said.

It meant there was an intention and commitment to find a way to better fund growing social care demand at a later date, the source said. There will be a Budget in November, a government spending review next year, and a social care green paper is due later this year.

The deal trailed today and expected to be detailed in a speech by Theresa May tomorrow was the result of intense negotiations between her, Philip Hammond and health and social care secretary Jeremy Hunt.

Well placed sources said the deal also included the Treasury agreeing to support the development of a ten year capital plan for the NHS; and to provide additional investment to the NHS education and training budget, as part of a national workforce strategy which is already being developed by Health Education England.

Both the Department for Health and Social Care and NHS England were successful in convincing the Treasury and 10 Downing Street that the new funding settlement for the NHS needed to be underpinned by investment in capital infrastructure and workforce planning, if it were to successfully transform services.

Mr Hunt has publicly argued the NHS should move from a “feast and famine” approach to spending and workforce planning to a a long term outlook.

HSJ understands that, following today’s announcement, NHS England will develop a ten year-plan for capital spending and development. The deadline for HEE’s ten year workforce strategy will be delayed to the end of the year, so that proposals can be submitted to the Treasury ahead of November’s budget, when full detail of the settlement will be revealed.

The Budget therefore is being seen as an important point to evaluate the government’s commitment on the other budgets. 

A broader plan for how services can be sustained and improved is also expected to be developed on a similar timetable, and NHS England has said it will create an “NHS Assembly” to advise on this. In its statement today Downing Street said the development of the plan would be led by “doctors”.

HSJ was also told by senior sources that there was recognition that public health spending needed to be sustained.

The sources said the commitments were not a guarantee of additional funding but indicated a willingness by the Treasury to go further than it has in recent years.

Social care, public health, and education and training budgets have all seen real terms cuts in recent years, while NHS capital budgets have been raided to support day-to-day spending.

Apart from social care, they are part of the DHSC budget, and have been reduced to help pay for growth to the NHS England budget. For the same reason DHSC internal budgets, spending on administration, and funding for other DHSC arm’s length bodies - like the Care Quality Commission - have seen similar constraint.

The funding deal announced today - of real terms growth averaging 3.4 per cent a year - also applies only to NHS England.