However, the current funding settlement only applies to the NHS England budget. This excludes key areas of NHS spending, such as health visiting, training doctors and nurses, and the investment needed to build, equip and maintain hospitals, community and primary care facilities. The full DHSC budget remains the most accurate way to define health care spending, as it provides the full picture of resources available for patient care.

Whether the NHS will be able to start to transform care and outcomes over the coming years will depend to a large degree on spending on the areas of health that fall outside NHS England’s budget. If these budgets are not increased in real terms, total health spending will rise by an average of just 2.9% a year for the next 5 years. This is below the minimum level that Health Foundation and Institute for Fiscal Studies (IFS) analysis found is needed to maintain quality and access to care.

Education and training

Health Education England (HEE), the body responsible for the education and training of NHS staff, has a budget of £4.2bn for 2019/20. Without investing more into two key areas of need – current staff and the training pipeline of new staff – the NHS’s major staffing shortages will worsen (as outlined in our recent analysis with The King’s Fund and the Nuffield Trust).

Investing £900m in HEE’s budget would allow national investment in workforce development to return to previous levels. It would also provide financial support for student nurses to improve their retention and engagement.

In the 2019 Spending Round, the government announced an increase of 3.4% in HEE’s programme spending next year (2020/21). This included £150m for workforce development and £60m for priorities set out in the upcoming People Plan. This falls short of the money required, but reverses some of the cuts to the development budget in recent years.