Spending Review: Fears over health budget promises

The NHS was high profile during the election campaign

Questions are being asked about the high-profile government promises made over health and social care spending.

Chancellor George Osborne claimed to have increased NHS spending as well as pumping an extra £2bn into social care in the Spending Review in England.

But shadow health secretary John Healey suggests the NHS figures do not add up, while campaigners fear social care may not see all the money.

The government said its plans meant NHS and social care were going to benefit.

The Tories made increasing NHS spending one of the central themes of the election campaign with the slogan "we will cut the debt, not the NHS".

Extra costs

The government said on Wednesday it had kept to that promise - the combined capital and resource budget will rise by 0.1% a year on average in real terms throughout this parliament.

However, in a letter to Health Secretary Andrew Lansley, Mr Healey said these rises ignore several extra costs the NHS is having to bear.

He said the government is taking £1bn a year out of the NHS for social care by insisting the health service invest in services that overlap with council social services departments, such as rehab care following discharge from hospital. He accused ministers of "double counting".

The bill for the shake-up of the health service - primary care trusts are being scrapped and GPs put in charge of local budgets - will also amount to between £2bn and £3bn over the next four years, while the VAT increase will cost £250m.

Mr Healey said: "The NHS will have to find these extra costs within a funding settlement which it is increasingly clear falls far short of what many in the NHS believed your government had promised."

These are on top of the extra long-term pressures from the cost of new drugs, obesity and the ageing population.

Independent experts, including the King's Fund and Nuffield Trust think-tanks, agreed a case could be made for saying the small real terms rise would be swallowed up.

The Nuffield Trust also raised concerns about the extra money earmarked for social care.

Of the £2bn a year extra that is being ploughed into the system by 2014, half is coming from a direct grant to local government.

But as councils are facing an overall cut of 27% in their budget from central government, the Nuffield Trust said social care may not end up seeing the extra money.

Jennifer Dixon, chief executive of the think tank, said: "The reality is that local authority budgets will be stretched and funds for social care are not ring-fenced, so the extra £1bn per year is by no means certain."

Stephen Burke, of Counsel and Care, the older people's charity, agreed it was a risk. He also said getting the NHS and councils to work together to make sure the £1bn of NHS funds benefited social care was a "major challenge."

He said in the past the two sectors had often failed to work together.

Health Secretary Andrew Lansley rejected Labour's criticisms and said the opposition was comparing different numbers from different sources.

He added: "We said in our Spending Review that up to £1bn of the NHS capital budget will be made available to be spent on measures that support social care and benefit health, by the end of the Spending Review.

"Without adequate social care, people would be admitted into hospital unnecessarily, and beds would be blocked because people could not be cared for at home. So this investment benefits both health and social care."