Spending Review 2025: A Mixed Picture for NHS, Social Care, and Communities

The latest Spending Review has awarded the NHS a higher funding uplift than many other public services, a reflection of continued government commitment to healthcare amid significant fiscal pressures. The commitment to a real-term increase of 3% per year over the next three years is welcome, and we look forward to this spending increasing the speed of diagnosis and easing waiting times. It is, however, vital that the Government ensures the extra investment is deployed in the areas of greatest need, inclusive of supporting the 25 million people living with long-term conditions.

We welcome a commitment to introducing a Fair Pay Agreement for social care workers, which will help bring more people into the social care workforce. But, without information on pay costings, it is unclear how much of the welcome, but modest, additional local government uplift will be available to ease unmet social care demand. For example, unfair burdens on unpaid carers are yet to be addressed, and as is the alleviation of local authorities subsequently forced to make uncomfortable choices on who does and does not receive state-funded care. In addition to increasing system pressures, the lack of investment means real-world limitations on the lives of individuals.

Ultimately, rebuilding trust in the NHS depends not only on headline funding, but on visible improvements in access, quality, and equity, and on a sincere wider-government commitment to the wider determinants of health. The public and NHS staff all too often see the waste and inefficiencies of the system and reducing these means making sure the basics are in place – such as reliable admin and communication processes – as well as continuing to involve the public in how services should be reconfigured in the future to best work for and with their communities. We are also aware the major NHS restructure could result in significant redundancy costs – we do not want to see budget taken from front-line care as a result of this, as it risks minimising any funding uplift in the first 18 months of the Review’s lifetime.

Finally, the NHS app as new digital front door is welcome to streamline the current cluttered landscape of inconsistent online NHS access. However we must now see a clear offer in the 10 Year Health Plan for those who are digitally excluded, either through costs, access, skills, or language Barriers. Our NHS will fail to be a national service for all if people are given second class care due to challenges in using the NHS app. 

More broadly, it was heartening to see the proposed NHS spending clearly linked to enabling delivery of the 10 Year Health Plan. We share the Government’s hope to see such visible improvements in GP appointments, scan availability, ambulances, community investments, and digital innovation unfold with the upcoming publication, and implementation of the Plan.

Jacob Lant, Chief Executive of National Voices