As a result of briefings to media over Monday evening, some of the big questions about what tomorrow’s comprehensive spending review announcement means for health have already been answered.
We know that NHS England has secured a significant “frontloading” of the £8.4bn real terms increase to its budget promised for the coming half decade, with £3.8bn coming in the first year of the parliament.
We also know that other areas of Department of Health spending are not going to receive the same largesse, with nurse education – for example – expected to be switched over to a student loans funding system.
However – as with all pre-briefings – there are still significant questions to be asked about the health settlement. Here is HSJ’s view of the most important things to look out for tomorrow:
What will happen to the Department of Health’s overall budget?
This is the big question. Information released so far indicates that the Treasury is now defining the “ringfence” on NHS spending as applying only to NHS England’s budget (£101.7bn) and not to the Department of Health’s total departmental expenditure limit (£116.6bn), as it was in the previous parliament. This would mean the same level of protection did not apply to public health spending, health education or the budgets of arm’s length bodies such as Monitor and the Care Quality Commission.
However, until figures are released tomorrow for the department’s budget over coming years, we do not know how much of the £8bn growth promised to NHS England is new money, and how much will come from a squeeze on other areas of department spending. Think tanks such as the Health Foundation and the Nuffield Trust have argued forcefully that big cuts to some of these budgets will have knock-on effects on frontline care.
How bad will it be for social care?
The Five Year Forward View is predicated on existing social care services being maintained. This is unlikely to happen – but the extent of the damage to social care will take some time to become apparent. We will find out tomorrow how much council grants, which fund social care, will be cut by. Exactlyhow much funding will be reduced by in each area will not be known until councils publish their budgets. The picture will be complicated by the likely announcement that local authorities will be allowed to raise council tax to fund social care.
Will social care benefit from the NHS funding boost?
In April, Jeremy Hunt told HSJ that social care would benefit from rising investment in the health service, potentially via budget-pooling mechanisms such as the better care fund. The better care fund was announced in the last spending round: tomorrow we will find out what happens next.
Will the better care fund continue, and in what form?
The better care fund is likely to continue in 2016-17, at the same level as 2015-16 and uplifted for inflation. HSJ understands the better care fund pooling will exist as a minimum option beyond this year, too, but in later years most areas will be expected to have chosen more radical options for health and care integration, whether that be devolution arrangements, new integrated provider models, or something more different. Ministers have previously said bringing about the full integration of health and care services is their ultimate ambition.