The government has committed to protect the NHS from spending reductions. Prior to the review the Chancellor announced that the NHS will receive an additional £10 billion a year above inflation by 2020. The NHS budget for England and Wales will rise to £120 billion by 2020, from £101 billion.
Scotland, Wales and Northern Ireland will receive relative increases with each government deciding where this will be spent.
In total, the Spending Review makes a commitment of more than £500 billion to funding the NHS by 2020. The Chancellor announced an extra £3.8 billion to frontload investment and to reduce the current financial pressure on the NHS. According to The Guardian the extra NHS spending is set to be £3.8 billion in 2016/17, £1.5 billion in 2017/18, followed by a slowing down in the rises in the next two years, before a bigger rise in 2020/21.
This increase in the NHS budget is good news for stroke treatment overall, particularly acute and primary care. It means there will be extra funds available for front line health services. In the review, the government has highlighted its support for more financial stability for individual health trusts and the delivery of seven-day services. This is important because strokes are medical emergencies and they don't only happen on weekdays. The funding will go some way to providing the resources needed to deliver full services to treat stroke patients and give them a better chance of recovery whatever day of the week they are admitted to hospital.
Specifically, the Treasury said the extra funding will allow the NHS to offer 800,000 more operations and treatments, 2 million more diagnostic tests, 5.5 million more outpatient appointments and spend up to £2 billion more on new drugs.
The good news for the NHS does not extend to all areas of health services. According to the Health Service Journal, the Spending Review revealed a 21% cut to non-NHS England health budgets, so money spent on health education, public health, and capital projects may be subject to huge cuts over the five years.
The decrease in funding for public health is a particular concern to the Stroke Association because public health campaigns and services play a vital role in supporting people to reduce their risk of stroke and helping people recognise the early signs of the condition to get treated.
A good example of how public health resources have made a difference to stroke prevention is the FAST campaign, which has been a hugely effective tool to raise awareness of stroke. Public Health England evaluation of the campaign saw a 70% rise in the number of emergency calls for stroke, meaning that 40,000 more people got to hospital within three hours of their stroke symptoms starting and nearly 4,500 fewer people became disabled as a result. Figures showed that although the campaign cost £12.5m it provided a return of investment of £332.9m including decrease in care costs and benefit to the state.
It isn’t just the FAST campaign. Other general programmes to improve activity levels and reduce obesity are also crucial for stroke prevention. A sedentary lifestyle increases your risk of an ischaemic stroke by 50% being overweight increases your risk of ischaemic stroke by 22% and being obese by 64%. There is a great deal that public health can do to reduce the number of strokes. Without long-term investment in public health, problems for frontline NHS services as well as social care will continue to mount up.
Unlike the NHS other government departments have seen reductions in their budgets, including the Department of Communities and Local Government. Cuts to local authority budgets of 6.7% could have a significant impact on the local services the Stroke Association provides to stroke survivors, leaving people without vital support after their stroke.
The Chancellor gave local councils in England and Wales a new power to raise funds. Local councils will be able to raise council tax by 2% in their areas if they ring-fence the funding for social care. However, as members of the Care and Support Alliance (CSA) we support the view that even if councils raise the full 2% that will only provide £2 billion until 2020 which is insufficient to meet the social care crisis.
We also have concerns that money raised through tax will mean that wealthier areas will be in a better position to raise funds than more deprived regions. People from the most economically deprived areas of the UK are around twice as likely to have a stroke and three times more likely to die from a stroke than those from the least deprived, so this risks increasing the inequality that already exists.
The Chancellor also announced that the Better Care Fund will benefit from £1.5 billion funding to support integration for health and social care services which the Stroke Association supports. However, the CSA estimates the potential income that could be raised from these announcements amounts to almost £3.5 billion, which does not come close to dealing with the significant funding gap and meeting the social care demands.
Stroke is one of the largest causes of disability and over a third of stroke survivors in the UK are dependent on others. 48% of stroke survivors and their carers tell us problems are caused by poor coordination between health and social care providers. This means many survivors are not getting health and social care services beyond hospital.
The Stroke Association is already aware that a number of Local Authorities have already faced years of budget cuts. This announcement means even more services, including Stroke Association services, are under threat. We're very concerned about the impact that cuts will have on stroke survivors and their families.
Science and research
The budget for scientific research sits within the Department for Business, Innovation and Skills (BIS). While the BIS budget is being cut by 17%, the Stroke Association is delighted that science and research funding is to be protected.
We particularly welcome the increase in the science budget to £4.7 billion, this is absolutely critical if we are to continue to make the advances we need in medical research. In stroke, there is still so much more to do, the Stroke Association has spent more than £50 million on research and we rely on support and continued investment from the government to make our progress in this condition possible. Funding for UK stroke research still lags behind other major conditions, despite the fact that stroke is the single biggest cause of adult disability. Increased investment in research into stroke is vital if we are to reduce the burden of this condition.
Building the capacity and strengthening the leadership of stroke research in the UK is one of our own strategic targets, which can only be met by this crucial commitment from the government that will allow UK medical research to continue to grow, bring benefit to patients and ultimately to reduce burden of stroke on our population and our NHS.