The UK Prime Minister says there can be no extra NHS funding without reform. At the same time, Wes Streeting, the Health Secretary, says the Department of Health and Social Care policy is that the NHS is broken.
So, if there is no new money and the system is broken, some funds must be reallocated to fix the problems. But where does all the money currently go?
First, we need to understand the structure of the NHS and its key organisations. The House of Commons Library has a handy research briefing that provides an overview of funding and accountability arrangements within the NHS in England.
NHS England provides oversight for the health service. The providers include NHS trusts, foundation trusts, primary care organisations, and private and voluntary sector providers. The Care Quality Commission inspects the quality of care. The Department of Health & Social Care is a ministerial department that says it supports ministers in leading the nation’s health and social care to help people live more independent, healthier lives for longer.
The structure is convoluted and, like pandemic preparation and decision-making, complicated.
Now that we understand the structure, we can examine where all the money goes.
England's total funding for health care was £169.9 billion in 22/23, £173.4 billion in 23/24, and £177.4 billion in 24/25.
The first thing you notice is that nearly £17 billion (10%) is given to non-patient-facing organisations and arms-length bodies such as the Care Quality Commission (CQC)
NHS England’s budget of £153 billion supports and oversees the commissioning of health services. With £107.8 billion going to integrated care boards
Of the remaining £41.1 billion - NHS England spends £29.8 billion on specialised services, general practice and other directly commissioned services (such as prison healthcare and offender services)
The remainder of the NHS’s England budget—we make that £11.3 billion—is spent on centrally administered projects and services (3.2 billion for the admin), including public health responsibilities such as vaccination and screening programmes.
In future posts, we’ll examine the figures to determine how much is spent in the back office and on the front. But so far, a cursory glance at the finances shows that heaps of cash doesn't go into patient care.
This post was written by two old geezers who can remember the days when getting something done cost peanuts.
I think this is such a useful exercise. Lot's of people shouting that too much money is spent on anything but patient care, and this exercise will hopefully help us understand the system.
It would be good to explore how much admin is actually needed for such an organisation. Are there business equivalents that can be used in terms of % of turnover used for admin and necessary support?
4.8 billion? Health education? Would this be pt education or staff education. In my 27 yrs as a pt, I never had “health” education. Today, we cannot even get an appt to see a gp. My “annual” visit to discuss my medications (for rheumatoid arthritis and hypertension) never take place in person, nor annually. This year I will have a five minute phone consultation….but not for at least another month. The nhs system is so broken, I honestly see no way back. How did it get this bad?