A £1.8bn cash boost for the NHS announced by Boris Johnson will largely be paid for with money that hospitals already have, a leaked letter has said.

The prime minister said earlier this month: "Don't forget that this is £1.8 billion of new money. It wasn't there 10 days ago."

But a letter - obtained by Health Service Journal and also seen by Sky News - says £1bn of the total will be funded by raising the Department for Health and Social Care's spending limit.

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Essentially, NHS trusts will be able to spend money they already have in reserve.

The letter, from NHS England and NHS Improvement chief financial officer Julian Kelly and dated 18 August, said: "For 2019/20, the government has agreed a £1bn increase in the Department of Health and Social Care [DHSC] baseline capital expenditure limit.


"This means that you can now revert to your original capital plans where these are funded by your trust's own income and reserves or where DHSC has already approved the business case or funding for programmes."

The question of whether the money is "new" was raised when the announcement was made earlier this month.

Helen Buckingham, director of strategy at the health think tank the Nuffield Trust, told Sky News at the time: "We definitely think there is a bit of clever accounting going on... We think at least £1bn of this £1.8bn is... money that the NHS has already got and is now being allowed to spend."

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A Department of Health and Social Care spokesperson said: "The NHS has an extra £1.8 bn of new funding to invest in projects, money which the NHS did not previously have to spend.

"This is a brand new injection of capital that enables the NHS to get on and release urgent planned investment this year.

"This includes £850m which will directly fund 20 new hospital upgrades - money that had not been previously allocated.

"We will consider proposals from the NHS for a multi-year capital plan in the upcoming spending review."