1. Representation to the 2015 Spending Review The Health Foundation September 2015

2. About the Health Foundation 2 The Health Foundation is an independent charity working to improve the quality of health care in the UK. We are here to support people working in health care practice and policy to make lasting improvements to health services. We carry out research and in-depth policy analysis, fund improvement programmes to put ideas into practice in the NHS, support and develop leaders and share evidence to encourage wider change. We want the UK to have a healthcare system of the highest possible quality – safe, effective, person-centred, timely, efficient and equitable.

3. 3 Figure 1: Public spending on health in the UK 1949/50 to 2013/14 in 2014/15 prices, and as a percentage of national income

4. 4 Table 1: Health expenditure in England from 2009/10 to 2015/16 2009/102010/112011/122012/132013/142014/152015/16 health expenditure, cash terms (£) 98,419100,418102,844105,222109,777113,300116,574 annual change, cash terms (%) 2.02.42.34.33.22.9 health expenditure, 2015/16 prices (£) 109,341108,558109,226109,976112,419114,433116,574 annual change, real terms (%) -0.70.60.72.21.81.9 Source: PESA 2015 Note: health expenditure is measured as total department expenditure limit, excluding depreciation

5. 5 Table 2: Average annual increase in hospital activity based on providers ‘time series, 2008/09-2014/15 2008/09-2009/102010/11-2014/15 Outpatient first attendances7.6%2.1% Total inpatient admissions2.8%2.0% of which: non-elective3.2%1.0% elective2.6%2.8% A&E Attendances4.7%1.1% Source: NHS England A&E attendances and Monthly hospital stats

6. 6 Figure 2: Average annual increase in hospital activity based on providers’ time series, 2009/10-2014/15

7. 7 Figure 3: Change in number of trusts in deficit from 2012/13 to 2014/15 Surplus Deficit

8. 8 Figure 4: change in annual productivity for the acute sector from 2009/10 to 2013/14

9. 9 Table 3: Expenditure by Councils with Adult Social Services Responsibilities (CASSRs) by accounting category, 2009/10 to 2013/14, England, £bn in 2015-16 prices 2009/102010/112011/122012/132013/14 Change 2009/10 to 2013/14 Average annual change Net current expenditure 16.115.815.715.315.0-7%-2% Source: NASCIS PSS-EX1 return

10. 10 Figure 5: Indexed growth in real total gross expenditure on Adult Social Care in England and demographic pressure, 2007-08 to 2012-13

11. 11 Figure 6: Number of clients receiving services (community-based services, residential care or nursing care) provided or commissioned by local authorities with social services responsibilities, by client type, 2009/10 to 2013/14, England

12. 12 Figure 7: Need for and receipt of help with Activities of Daily Living (ADLs) in the last month, by equivalised household income and sex

13. 13 Table 4: Estimated budget for English NHS in 2019/20 and 2020/21 according to the manifesto commitment, assuming inflation rises as assumed for GDP Deflator, July 2015 2015/162019/202020/21 TDEL plus real terms £8bn increase by 2020/21 (2015/16 prices) £116.6bn£122.9bn£124.6bn TDEL plus real terms £8bn increase by 2020/21 (cash terms) £116.6bn£132.4bn£137.5bn

14. 14 Table 5: Meeting the manifesto commitment – implied increases in the NHS England, Public Health England and Health Education England – all financial figures in billion, stated in cash terms 2015/162019/202020/21 Average annual change in cash terms Average annual change in real terms TDEL plus £8bn real-terms increase by 2020/21 (cash terms) £116.6£132.4£137.53.4%1.3% NHS England receives £8bn (cash terms) £101.1£115.8£120.53.6%1.5% PHE budget rises at same rate as NHS England (cash terms) £3.7£4.2£4.43.6%1.5% PHE budget received from Department of Health rises at same rate as NHS England (cash terms) £0.9£1.0 3.6%1.5% HEE budget rises at same rate as NHS England (cash terms) £4.9£5.6£5.83.6%1.5% Remainder (cash terms)£9.7£10.0£10.21.0%-1.0% Amount of remainder for Capital£4.6£4.8 1.0%-1.0%

15. 15 Table 6: The affordability challenge as set out in Monitor planning guidance 2014/152015/162016/172017/182018/19 Total affordability challenge3.1%6.6%5.5%4.7%4.6% Provider efficiency2.0%2.5%2.0% System efficiency1.0%2.0%0.1%1.0% Remaining challenge0.1%2.1%2.5%1.7%1.6% Remaining Challenge (£)£1.46bn£1.7bn£1.26bn

16. 16 Figure 8: Provider forecasts of future demand – 2012 and 2013 forecasts

17. 17 Figure 9: Average weekly earnings in the public and private sectors December 2000 – June 2015 (rolling 12-month averages

18. 18 Figure 10: Annual average real-terms change in average earning per person from 2009/10 to 2013/14

19. 19 Figure 11: Difference between public and private pay, January 2008 to June 2015

20. 20 Table 7: Transformation Fund costs, 2016/17 to 2020/21 (2015/16 prices) 2016/172017/182081/192019/202020/21 Efficiency Strand £1.1bn Development Strand £0.4bn£0.8bn£1.0bn £0.7bn Total Transformation Fund £1.5bn£1.9bn£2.1bn £1.8bn

21. Keep in touch For all the latest news and developments from the Health Foundation: Visit our website at www.health.org.ukwww.health.org.uk Subscribe to our monthly email newsletter at www.health.org.uk/newsletter www.health.org.uk/newsletter Register for email alerts to be notified about our latest work at www.health.org.uk/updates www.health.org.uk/updates Take part in conversation and debate about current healthcare issues on our blog Follow us on Twitter, Facebook or LinkedIn. Keep in touch For all the latest news and developments from the Health Foundation: Visit our website at www.health.org.ukwww.health.org.uk Subscribe to our monthly email newsletter at www.health.org.uk/newsletter www.health.org.uk/newsletter Register for email alerts to be notified about our latest work at www.health.org.uk/updates www.health.org.uk/updates Take part in conversation and debate about current healthcare issues on our blog Follow us on Twitter, Facebook or LinkedIn. 21