By stewartb
The recent National Audit Office report entitled ‘NHS Financial Management and Sustainability’ makes substantive comments on the state of NHS England and the challenges it faces due to financial settlements over many years now from Westminster governments. Of course it makes ZERO reference to the knock-on consequences for the size of the Block Grants to devolved administrations and the resourcing of the NHS in NI, Scotland and Wales.
See https://www.nao.org.uk/reports/nhs-financial-management-and-sustainability-2024/
Just a few extracts from the NAO report help to reinforce the point for anyone willing to acknowledge how the Barnet Formula operates:
The NAO explains that ‘over the decade from 2014-15 to 2023-24, the resource expenditure of the NHS in England grew on average by 3.2% a year in real terms, which was less than the long-term average. From 1950-51 to 2013-14, resource expenditure on health grew on average by 3.6% each year in real terms. In the 10 years to 2023-24, expenditure increased by less than this and at markedly different rates at different times.‘ (my emphasis)
The NAO concludes that NHS England’s financial position is worsening because of a combination of long-standing and recent issues:
failure to invest in the estate – ‘The backlog of work needed to improve the NHS estate to an adequate level has increased greatly in recent years because of under-investment, reaching £11.6 billion in 2022-23, of which £2.4 billion (20.3%) related to the highest risk category of work.’ Without further capital investment, NHS England expects the NHS maintenance backlog to exceed £15 billion by 2027-28.
inflationary pressures – including the impact of higher-than-expected inflation which has increased the cost of medicines and other items beyond what the UK government allowed for in NHS England’s budgets. The NAO reports: ‘NHSE estimates that, in 2023-24, non-pay inflation cost an additional £1.4 billion above what was budgeted for. ‘
the cost of post-pandemic recovery – the NHS is still dealing with the pandemic’s legacy, including ongoing enhanced infection controls, operational and capacity constraints, and greater complexity in patient need. The NAO notes: ‘the NHS maintains a policy of leaving beds unoccupied if they are next to patients infected with COVID-19, reducing its efficiency. ‘
This is also noteworthy: ‘Delays in HM Treasury and DHSC’s approval of NHSE’s overall budget and planning guidance have meant NHSE has not agreed NHS systems’ spending plans until after the start of each financial year, making it very difficult for them to plan effectively.’
If NHS England lacks clarity over it annual budget allocation from HM Treasury and the DHSC, what lack of clarity must the administrations in Belfast, Cardiff and Edinburgh face in terms of the size of their Block Grants?
Notwithstanding the authoritative, balanced and reasoned assessment from the NAO about the state of NHS England in the context of Westminster government actions/inactions, the state of the NHS in Scotland – according to the BBC and almost all of the mainstream media that supposedly serve Scotland – is solely down to failures of government in Edinburgh. Knock-on impact on NHS Scotland from anything Westminster does or doesn’t do re -England’s NHS is of course ‘inconceivable’ – not so in Wales though!
Talking-up Scotland 'Albatraz' 
I wonder why spending under the Heath Government, 1970/74, was so high?
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Scotland is paying the debt on all Westminster useless policies. Brexit, Trident, nuclear, illegal wars, tax evasion. Scotland has no control over these decisions. So has to spend monies on worthless projects. Instead of NHS, Education, welfare. Scotland being short changed all the time.
Scotland raises £87Billion spends £54Billion. Westminster spends the rest. 40% but not on how people in Scotland want the monies spent. Then Scotland is given the false deficit.
Westminster spent £270Billion funding Covid. Much of it was wasted on worthless, non scrutinised project. Doubt if Scotland go £27Billion. Scotland still has to pay for it. The Barnett formula is a false project designed to take Oil & Gas monies out of Scotland and that is what it did. Took them off the balance sheet. Scotland’s block grant was cut. The Block Grant is limited. So Scotland cannot chose how much of its so called budget is spent.
180,00O defence personnel. 10,000 based in Scotland but Scotland has to pay for 18,000 on the Defence bill. Short changed. Scotland in surplus in fuel and energy and nearer the source, pays more. Brexit has lost £10Billion+ to Brexit. All these £Billions lost could have been spent on SNHS, Education and welfare but is not because Westminster decides the proportion. Scotland short changed and paying debts run up by Westminster.
Westminster raises £800Billion+ Spends £1000Billion+. In the whole UK Gov Accounts. Scotland raises more and spends less pro rata but is left with the rest of the UK debt. The Barnett Formula designed to take revenues out of Scotland. A false, fraudulent project. Thatcher illegally and secretly took revenues out of Scotland. Kept it secret under the Official Secrets Act. Westminster is still doing it.
With the Block Grant and trying to hide the information.
Scotland does not have the right to decide how the monies are spent. No taxation without representation. No democracy without a free and fair press. All powers are reserved to Westminster. Scotland would be better off Independent.
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ConDem coalition funding was so small. Austerity the start of it. Tory cut the NHS budget, no increase. Cut Education £6Billion a year. Cut welfare £16Billion.
NHS spending only increased. Covid funding £270Billion over two years. Doubt if Scotland got £27Billion. Much of it wasted on non scrutinised UK Gov contracts. The debt is still being paid off. Including £50Billion debt repayments a year.
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” The debt is still being paid off. Including £50Billion debt repayments a year. ” – The question should always be asked, ” To whom ?”
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Reeves claiming ‘blackhole’. More absolute nonsense. The finances are on the internet. It takes 10mins to look up. Reeves does not have the ability to look up the internet for 10 mins is not fit to be Chancellor. Same old, same old Labour. Lie after lie after lie.
£3Billion for war. No money for children. Eradicating child poverty would save £Billions. War is just a total waste of £Billions. Same old Labour. Bad choices.
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On the ‘black hole’ messaging coming from a surprised/shocked Labour Chancellor in advance of her promised big reveal next week, on BBC Radio 4’s Today programme this morning Institute for Fiscal Studies Director, Paul Johnson was asked whether it was credible for Labour to claim surprise at the state of government finances.
Johnson said: “I don’t think that is really credible at all. There should not be a sense of surprise there is a big issue here.” He pointed out that cuts in recent years and the way public sector pay has lagged behind the private sector meant that it was clear that public services would need investment.
And he noted: “The manifesto words [for Labour] ‘no new taxes on working people’, means that there can be no tax rises at all.” So more absolute nonsense?
I recall before the general election the IFS accusing Labour and the Tories of a “conspiracy of silence” in not addressing the reality of the UK’s public finances.
It may be that voters wake up too late to find they have elected a Labour government based on a false prospectus.
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