Chris Hopson, chief executive of NHS Providers, suggested a more fundamental assessment was needed of the sums required to run a 21st-century health service © Matthew Lloyd/Bloomberg

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Rishi Sunak trumpeted his healthcare spending review announcement as honouring the government’s “historic, multiyear commitment to the NHS”. But sector leaders and experts said the chancellor had fallen short of the sums needed to fulfil the government’s ambitious pledges for the health service while making up the ground lost through Covid-19.

Hailing a rise in the “core health budget” next year of £6.6bn, Mr Sunak said it would allow the NHS to deliver 50,000 more nurses and 50m more GP appointments, two key manifesto pledges on which Boris Johnson won last year’s general election.

Capital investment would increase by £2.3bn to allow spending on new technologies and to replace ageing diagnostic machines, while also funding “the biggest hospital-building programme in a generation — building 40 new hospitals and upgrading 70 more”.

NHS Providers, which represents organisations across the healthcare sector, said that given the overall public expenditure pressures, the government had delivered “a constructive response”.

But Chris Hopson, chief executive, said: “It’s impossible to work out what the total additional funding needs associated with Covid-19 might be for next year.” The government should continue to honour its promise to give the NHS whatever it needed to continue to manage the impact of the pandemic, he said.

Mr Hopson suggested that a more fundamental assessment was needed of the sums required to run a 21st-century health service.

The pandemic had “brought into sharp relief the question about whether as a nation, with demand increasing, we are investing enough in our health and care system to provide the quality of care and support that is needed. That question has been overlooked for too long,” he said.

Anita Charlesworth, director of research for the Health Foundation, a charity, said the spending review had not provided enough next year to give hospitals the resources they needed to deliver care while also meeting requirements on social distancing and heightened infection control. “As a result, there will be a total shortfall for NHS England of around £6bn next year,” she said. 

She also regretted the absence of additional money to start “rebuilding public health following years of cuts”.

Other experts expressed concern at Mr Sunak’s failure to allocate more money than he did for social care — and worried that the prime minister might be downgrading his resonant promise when he entered Number 10 last year to “fix social care once and for all”.

Mr Sunak said he would top up social care budgets by £1bn in 2021-22, just as he had done this year. Local authorities would also have additional flexibility to raise resources for social care through council tax.

The Treasury said on Wednesday that, in “the longer term”, the government was “committed to sustainable improvement of the adult social care system and will bring forward proposals next year”. But Richard Sloggett, former political adviser to Matt Hancock, the health secretary and head of health for the Policy Exchange think-tank, questioned whether this amounted to a “possible downgrade on full and long-lasting reform”.

Martin Green, chief executive of Care England, an industry body, said the promise of an extra £1bn for social care was welcome: “We welcome every penny, but in comparison with the NHS and the challenges that the sector faces, this figure is too little and too late.” 

The Health Foundation last year forecast a £4.4bn social care funding gap by 2023-24 to meet rising demand and address staff shortages. 

Ms Charlesworth said: “Government has unfortunately ducked reform again.”

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