No guarantee waiting lists will fall to hit targets, health leaders say
There is no guarantee NHS waiting times targets can be met, despite a Government boost in funding for the health service, leaders have said.
While the 3% increase in real terms for the health service per year has been welcomed, many health leaders are concerned about how they will bring down waiting lists, about possible future industrial action by NHS staff, and which services may need to be cut or redesigned.
Matthew Taylor, chief executive of the NHS Confederation, which represents all health organisations, said the NHS funding boost in the spending review was welcome, 'given the precarious state of public finances and will help the NHS to cope with rising demand from an ageing population, often with multiple or more complex physical and mental health conditions'.
But he warned that 'difficult decisions will still need to be made as this additional £29 billion won't be enough to cover the increasing cost of new treatments, with staff pay likely to account for a large proportion of it'.
He added: 'So on its own this won't guarantee that waiting time targets are met.'
Mr Taylor said NHS leaders will need continued backing from the Government to redesign services and balance budgets.
'That means getting political backing when some services are redesigned or cut, including moving hospital services into the community and closer to people's homes as part of the Government's three shifts,' he said.
He added that the 'flat settlement' from the Chancellor 'continues to leave a major shortfall in capital funding, and it also fails to lift the ban on private investment that is required to boost NHS capital funding'.
There is currently an almost £14 billion maintenance backlog bill to repair NHS hospitals and buildings.
Mr Taylor said those issues needed to be addressed in the upcoming national infrastructure strategy and 10-year plan for the health service.
Government documents accompanying the spending review show that, on average, from 2023-24 to 2028-29, the NHS in England will receive 3% real terms growth in day-to-day spending, equivalent to a £29 billion real terms increase in annual budgets.
The Department of Health and Social Care (DHSC) budget will increase by £2.3 billion in real terms by 2029-30, compared with 2023-24, 'representing a more than 20% real terms increase by the end of the spending review period', the documents said.
Overall, the figures suggest DHSC spending will rise 2.8%, though this is less than the average 3.6% in recent years.
Sarah Woolnough, chief executive of the King's Fund charity, said the 2.8% average increase in DHSC spending – or 3% for day-to-day NHS spending – 'will have been hard-fought for in the spending round negotiations, despite still being lower than the historical average the NHS has received over recent years'.
She added: 'We know there are already trade-offs happening in the NHS due to tight finances.
'The Chancellor said she wants the public to have 'an NHS there when they need it'.
'It is hard to see how all the things she mentions – faster ambulance times, more GP appointments and adequate mental health services and more – can be met on this settlement alone.
'Particularly when large parts of this additional funding will be absorbed by existing rising costs, such as the higher cost of medicines, which are currently being negotiated, and covering staff pay deals.'
However, she said the upcoming 10-year plan for the NHS could lead to better, more efficient services.
While capital budgets are increasing, 'they do so by nowhere near enough to rebuild or replace the tired facilities and equipment large parts of the NHS currently relies on, nor to develop the new hospitals and community facilities needed to deliver a modernised health service', she added.
According to spending review documents, the Government expects the NHS to deliver 2% productivity growth each year, 'unlocking £17 billion savings over three years' to reinvest back into the NHS to improve patient care, it said.
The Government will also invest up to £10 billion in NHS technology and digital transformation by 2028‑29, it said.
NHS England boss Sir Jim Mackey, speaking at the NHS ConfedExpo conference in Manchester, said the NHS has done 'really well relative to other parts of the public service'.
He added: 'But we all know it's never enough because of the scale of advancement, all the ambition, all things we want to do, the day-to-day cost pressures we're trying to get on top of, etc.
'We're always going to be in a world where we want more money, but I think everyone's starting to accept and understand that we've got what the country can afford to give us.
'We really need to get better value for that money – it is broadly the equivalent of the GDP of Portugal, so it's a huge amount of money by any standards.'
When it comes to waiting times, Prime Minister Sir Keir Starmer has pledged to slash them, saying the NHS will carry out 92% of routine operations within 18 weeks by March 2029.
However, in March this year, the NHS waiting list for hospital treatment in England rose for the first time in seven months.
The data showed an estimated 7.42 million planned treatments were waiting to be carried out at the end of March, relating to 6.25 million patients, up slightly from 7.40 million treatments and 6.24 million patients at the end of February.
Officials have said that rise was not unusual given the time of year, but only time will tell whether the overall waiting list can continue to drop enough to hit the Prime Minister's target.
Most NHS trusts describe the financial position of their organisations as challenging, with recent pressures including the cost of dealing with strike action by staff and more longstanding issues such as inflation, rising energy and fuel costs.
NHS England has already budgeted a 2.8% increase in pay for staff in 2025/26, but many leaders the King's Fund spoke to were worried about funding pay rises above this amount.
After the spending review, Royal College of Nursing (RCN) general secretary, Professor Nicola Ranger, said staff will now decide whether the 3.6% pay rise offered by the Government is enough.
She added: 'Against a backdrop of other cuts, nursing staff will see the NHS being protected but not transformed by today's spending plans.
'When the Government lays out its vision for the future of the NHS and its workforce, it must say how it intends to reverse collapsing student recruitment, boost retention and deliver urgent, structural reform to nursing pay.'
Nuffield Trust senior policy Analyst Sally Gainsbury said: 'Compared to the settlements for other departments – from policing to education – the NHS deal looks generous.
'But seen in the context of all the promises made by the Government to the British people – to drive down waiting lists, shift care closer to home, rapidly improve tech – and the commitments to meet staff pay demands and rising costs of new drugs, today's settlement soon melts away.
'With capital funding staying flat in real terms for the rest of the spending review period, it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the Government's ambitious productivity targets.'
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