NHS will continue to be a ‘sickness service’ unless community healthcare funding prioritised, analysis suggests

Acute and emergency care services are ‘swallowing up’ healthcare budgets, leaving community services without the funding they so desperately need, according to a new analysis by the Nuffield Trust.

The analysis reveals that while funding for some NHS services have seen real terms increases (e.g. acute, ambulance and mental health services), overall funding for NHS community healthcare has grown much more slowly, with some areas experiencing cuts.

Successive governments have committed to moving care closer to people’s homes, with a key focus on preventing ill health and moving away from the current model of the NHS as a ‘sickness service’. However, the Nuffield Trust says this analysis calls into question these commitments, with successive governments failing to ‘put their money where their mouth is’.

Funding for community healthcare has risen by just 0.5% over the past six years

The analysis of NHS funding by care sector is drawn from the detailed annual accounts of all 212 NHS provider trusts, supplemented with information from annual accounts from NHS England and the Department of Health and Social Care.

It reveals that total funding for NHS-run patient care services has increased by 3.1% a year since 2016/17, but this increase has not been applied equally to different sectors, with funding for community and prescribing services only rising by 0.5%, and public health and dentistry experiencing real terms cuts.

Indeed, of the nine NHS service funding lines examined in the analysis:

• Four experienced average annual real-terms increases over the period: acute services (4.4%) mental health (5.3%), ambulances (5.2%) and GP primary care (3.3%).
• Three experienced average annual real-terms cuts: public health (-3.9%) dentistry (-2.2%), ophthalmic and pharmacy spend (-2%).
• Two were broadly flat: community services (0.5%) and prescribing ( –0.5%) on average each year over this period.

The picture is even more stark once these figures are ‘needs adjusted’ to take account of our ageing population and increasing healthcare need. In 2022/23, needs-adjusted spending on NHS community health services was 4.2% below where it was in 2016/17.

This means when demand for services is taken into account, these services received £6 less per person in 2022/23 than they did seven years ago. Cuts to public health spending (e.g. health visiting, school nursing, and promotion of good health) are even greater, at £15 (24%) per person.

“Successive governments have cut back on the very services that are needed to support the ambition of moving care out of hospital”

Nuffield Trust Senior Policy Analyst Sally Gainsbury says the analysis reveals that successive governments have failed to fulfil their commitment to funding community services and ultimately, this means care will continue to be mostly carried out in hospitals, putting added pressure on an over stretched NHS.

“For over a decade, policymakers have rightly claimed that if the NHS is to be more than a sickness service, we need to develop and boost services that actively keep people out of hospital by managing long term conditions in their homes and preventing illness and chronic health deterioration.”

“But our analysis reveals that the opposite is true when it comes to how much money is being invested in different forms of healthcare, with striking falls in needs-adjusted spending per person in key community and primary care services. Quite simply successive governments have cut back on the very services that are needed to support the ambition of moving care out of hospital.

“These trends are not an accident: when the chips are down, it’s the blue-light emergency services that swallow up what funding is available for healthcare in straitened times. Whoever forms the next government will have a mountain to climb to reverse this trend without detracting from the very real spending pressures in acute care,” she said.