Tag Archives: NHS

Key Takeaways from the Spending Review: A future that is less generous than the past

GK had the pleasure of hosting former Treasury and education minister David Laws and the Financial Times’ Economics Commentator Chris Giles in our latest webinar on Thursday (12th June) to discuss the winners and losers from the government’s spending review, and what it means for business.

The spending review is a significant moment in the political calendar. The settlements it confirms set departmental day-to-day budgets for the next three years (2026-27, 2027-28 and 2028-29) and capital expenditure for the next four (until 2029-30). It is also the moment when No.10 and the Treasury must publicly commit the funds to support their political objectives – in essence, we get to see where spending is going to be prioritised and where it is not.

In the webinar, David and Chris detailed what the spending review means for overall public spending, where the government could come undone, and the possibility of future tax rises. You can read a summary of their key takeaways below:

The spending review is not about making new money available or introducing new taxes. Spending reviews are all about the allocation of a pre-determined spending envelope which, in this instance, the Chancellor set out in the October budget last year. It does not introduce any new taxes or make new money available. Instead, it confirms what areas of public spending the government wants to prioritise, and which departments will have to be squeezed.

The departmental settlements do not represent a return to the austerity years. While the overall spending envelope is tight – especially given growing pressure on public spending across health, pensions and defence – day-to-day spending is still rising by 1.2% per year in real terms (i.e. accounting for inflation) over the spending review period. This means it is broadly in line with the departmental spending settlements put forward by various governments since 2019.

A lot of the spending assumptions depend on public sector productivity improving, which is no guarantee. Public sector productivity has declined since the Covid-19 pandemic and in 2024 it fell by 0.3%. The Office for Budget Responsibility (OBR) has historically assumed quite generous improvements in public sector productivity each year which is a key component of its overall economic growth metric.

If the OBR significantly revises down its assumptions about improvements in productivity, this could seriously impact the funds it is projecting the government will have to work with over the spending review period. This increases the likelihood of the government having to do introduce large tax rises at the autumn budget.

Defence will continue to put pressure on the government’s overall spending envelope. Since the end of the Second World War, successive governments have used cuts to defence as a means of boosting other areas of public spending, most notably health. Persistent global instability and geopolitical uncertainty means that higher levels of defence spending are likely to continue for the foreseeable future. No.10 and the Treasury will have to contend with this new spending pressure as demographic challenges continue to pile up and economic growth remains sluggish.

The NHS is the big winner from the spending review, albeit with a smaller settlement than it has historically received. Health secretary Wes Streeting will undoubtedly be the happiest around the Cabinet table following the confirmation of the Department of Health and Social Care’s settlement, with spending on the NHS set to grow by 3% per year in real terms. However, this is below historic average rises of approximately 4-5%. With a growing elderly population and people living with complex conditions for longer, the funding put forward in the spending review settlement is unlikely to significantly move the dial on the performance of the NHS.

Small tax rises are likely at the autumn budget to meet the Chancellor’s fiscal rules. The government has committed to meet day-to-day expenditure through its own revenues by 2029-30. This means its current budget will have to be in balance or surplus by the end of the decade, and any money the government does borrow will be to invest. If the OBR projects that the government is not on course to meet this fiscal rule (or any of its others), then Chancellor Rachel Reeves will be forced to come back for a second round of tax rises or decide to break a fiscal rule. Either look fairly unpalatable to the government given where they currently are in the opinion polls.

A cabinet reshuffle should be expected in the second half of 2026 as the government begins to ramp up to the next general election. 2026 is projected to a big election year in the UK. Elections are due to take place for the Scottish Parliament and Welsh Assembly, along with a series of newly created unitary authorities. Should the results prove poor for Labour, as current polling indicates they will, then Prime Minister Keir Starmer is likely to reshuffle his cabinet to get his top team in place as the No.10 machine starts to think about the next general election in 2029.

GK Strategy in Conversation with Steve Brine and Richard Meddings

GK Strategy was pleased to host former Chair of NHS England Richard Meddings and former health minister and Chair of the Health and Social Care Committee Steve Brine for an ‘in conversation with’ discussion on Thursday 15 May to examine some of the challenges facing the government, the Department of Health and Social Care and the NHS 10 months into Labour’s term in office.

Meddings and Brine took a deep dive into a range of issues affecting the health and social care sector, exploring the implications for investors and service providers. From funding pressures to the abolition of NHS England, the discussion drew on our speakers’ extensive experience to evaluate the road ahead for the health system and the reforms the government will need to deliver to meet its ambitious policy objectives.

Much of the discussion focused on the NHS and the role of ICBs in a reformed health system following the announcement that NHS England would be abolished. There was agreement that health secretary Wes Streeting had received a tough inheritance, including mounting pressures on the health service and a poor fiscal climate making a significant injection of additional funding unlikely. The panellists highlighted the urgent need to redesign governance frameworks that better meet the demands of a modern health service.

Meddings and Brine spoke in detail about the role of technology in reforming the delivery of healthcare. They agreed there needs to be a steady stream of investment to maximise the increasing role AI will play in improving patient care and delivering efficiency savings within the NHS. The pair emphasised the need for Streeting to secure the ear of Chancellor of the Exchequer, Rachel Reeves, who they argued will need to prioritise health targets despite a constrained financial budget.

The two panellists agreed that reducing the elective care backlog and meeting the 18-week referral to treatment target was the key retail offer to voters at the general election and will be the main health priority for the government. This is despite wider initiatives that might have more significant long-term outcomes for the health of the UK’s population. Other short-term priorities for the NHS that were discussed included reducing the number of people in urgent care, increasing access to primary care, and improving cancer detection rates.

Towards the end of the session, the discussion shifted to the upcoming 10-Year Health Plan which will set out the government’s healthcare reforms in detail. Meddings and Brine agreed it is likely to prioritise prevention, the shift from hospital-based to community care and greater digital integration, which were the three ambitions put forward by Labour pre-election. The panellists highlighted that meaningful progress will depend on early intervention strategies and targeted investment, particularly in tackling obesity, cancer and mental health challenges.

For investors and stakeholders, the panel’s message was clear: steady investment in health, coupled with a pragmatic embrace of technology and AI presents a significant opportunity to reshape the delivery of healthcare at a time when demands on the NHS continues to rise.

Health, social care, and life sciences is one of the GK’s core sectors. GK supports a range of businesses and investors to navigate the political, policy and regulatory landscape and help them to realise their commercial objectives. Please get in touch if you would like to discuss the impact of politics and policy on your business or investment decisions.

Policy Spotlight: Health

GK Strategy is pleased to share its ‘Health Policy Spotlight’ report which sets out some of the key health policy trends to watch out for in 2025 as we look ahead to the government’s eagerly anticipated 10-Year Health Plan.

The report can be accessed here: Health Policy Spotlight – GK Strategy – March 2025

Unpacking the government’s 2025 mandate to NHS England

At the end of January, Secretary of State for Health and Social Care Wes Streeting delivered the government’s 2025 mandate to NHS England. This is a crucial document which sets out the health secretary’s goals for the health service over the next 12 months. It also provides all-important detail about the government’s emerging views on reform of the health and social care system ahead of the much-anticipated 10-Year Health Plan, due to be published later this year – likely in June or July.

The findings of Lord Darzi’s investigation into the health service, commissioned and published in the weeks immediately following Labour’s general election victory, have unsurprisingly been hugely influential in shaping the development of Streeting’s inaugural mandate to NHS England. The health secretary has said the mandate will help address the urgent challenges identified by the Darzi investigation and includes a ‘sharp focus on improving efficiency and productivity.’ Streeting again warns that the ‘culture of routine overspending without consequences’ is over.

At the heart of the 2025 mandate are three key aims: reducing waiting times, improving access to primary care, and improving urgent and emergency care. To reduce waiting times, Streeting has said he is refocusing the NHS on making progress towards an 18-week standard, whereby 92% of patients wait no longer than 18 weeks from referral to treatment, which will work in tandem with the steps set out in the government’s Elective Reform Plan published earlier this year. Patient choice is also at the heart of this agenda. The mandate emphasises the importance of implementing a cultural shift in the NHS to prioritise the patient experience in reducing waiting times, including through the use of the private sector to enable greater patient control over their treatment.

Improving access to primary care is the second key aim of the mandate. This mirrors one of the three strategic shifts the health secretary wants to see as a result of his reform agenda: shifting more treatment from hospitals to communities. Streeting is clear that primary care services are the front door to the health service but for too many people it is not possible to get a timely appointment, if at all. The mandate requires NHS England to enable patients to access general practice more quickly and tackle ‘unwarranted’ variation in services provided by general practice.

Improving urgent and emergency care is the mandate’s third aim. The mandate labels ambulance response times and waiting times in A&E as ‘unacceptable’. While the health secretary recognises that transforming these services will take time, he does state that a start must be made ahead of the government publishing its strategy to improve urgent and emergency care later this year. The mandate therefore includes a specific focus on reducing long wait times to improve patient safety, experience and outcomes.

The ambitions set out by Streeting in his first mandate are laudable. The bleak fiscal situation means the health secretary will have a hawk-like focus on monitoring performance against budgets. This is in recognition that the uptick in funding that the Department of Health and Social Care received at the October budget is unlikely to point to further significant cash injections in the immediate future. For providers, it also underscores the importance of positioning themselves as a high-quality, value for money partner to ICBs and NHS Trusts in delivering strong outcomes for patients.

If you would like to discuss the 2025 NHS mandate in more detail and what it means for businesses in the sector, then please contact Hugo Tuckett (hugo@gkstrategy.com) or Arth Malani (arth@gkstrategy.com).

Maternal Health: Where does the government go from here?

In September 2024, Secretary of State for Health and Social Care Wes Streeting labelled the state of maternity services in England a ‘cause for national shame’, describing it as one of the ’biggest issues that keeps him awake at night’.

His comments followed the publication of a damning report by the Care Quality Commission (CQC) which brought together findings from 131 inspections and found that almost half of maternity units inspected were rated as ‘requires improvement’ or ‘inadequate’. The report called for increased national action and ring-fenced investment into services, warning that poor quality NHS maternity care will become normalised if action is not taken.

In January 2024, the APPG on Birth Trauma launched an inquiry to investigate the factors in maternity care that contribute to birth trauma and develop policy recommendations. By May, the APPG’s report, Listen to Mums: Ending the Postcode Lottery on Perinatal Care, presented findings from over 1,300 submissions by women recounting harrowing stories of inadequate and traumatic care. The report identified an overwhelming narrative that women felt belittled, ignored, and neglected at a time when they were most vulnerable, and concluded that a base standard in maternity services is needed across the UK.

Streeting has inherited a bleak forecast: urgent need for reform; mounting pressures on the NHS as a whole; and a poor fiscal climate. So where does Labour go from here?

Labour’s 2024 election manifesto promised to ensure that NHS trusts failing on maternity care are ‘robustly supported into rapid improvement’, to train thousands more midwives as part of the NHS Workforce Plan, and to set an explicit target to close the black and Asian maternal mortality gap.

However, the party’s manifesto lacked any concrete policies aimed at fixing the broken maternity system. This means all eyes now turn to the government’s 10-Year Health Plan, due to be published in spring this year, as the potential roadmap for change.

While the plan will focus on prevention, the transition from hospital to community care, and the digitalisation of health services, the government has given no indication of whether it will give maternal health the attention it desperately needs.

Despite rising demand, current services are stretched and under-resourced, meaning many women face significant delays receiving the support they need, if they receive it at all. Investing in early intervention, services that understand the needs of new and expectant mothers, and workforce growth is essential to ensuring that patients can access timely and effective support.

Various campaign groups are putting pressure on Streeting to make improving maternal health services a priority. The Maternal Mental Health Alliance is calling for all parties to demonstrate their support for new and expectant mothers. The Alliance claims ‘there is a vital opportunity for the new government to create positive change for current and future generations.’

The 10-Year Health Plan provides the government with the opportunity to address the alarming findings from both the CQC and APPG on Birth Trauma, restore public confidence in NHS maternity services, and show its commitment to fixing the systemic issues within maternal care. Inadequate support has devastating effects on families and adds huge costs to the UK economy, meaning it is vital that organisations engage with the government during the development of the 10-Year-Health Plan to ensure maternity services receive the focus they need. By leveraging industry platforms and policy development support, advocacy campaigns can emphasise the importance of maternal health and the challenges faced by women.

To discuss the government’s plans for maternal health in more detail, please contact Annabelle Black at annabelle@gkstrategy.com.