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More NHS funding in Scotland and Wales but cuts elsewhere

The devolved governments of Wales and Scotland have announced their budgets for next year.

Yesterday, the Labour-run Welsh Government, and the Scottish Government, run by the Scottish National Party (SNP), both outlined their draft fiscal plans for 2024-25 and how they would weather an ongoing financial storm.

“We have had to take incredibly difficult decisions – the starkest and most painful since devolution”

Rebecca Evans

In their 2024-25 budgets, both announced increases in funding for frontline NHS services – but acknowledged that these would have to come at the cost of cuts elsewhere.

In Wales, NHS funding will increase by £450m for 2024-25 on top of a £425m increase already made in October.

In addition, a planned 3.1% increase to the local government settlement, which funds social care among other services, would be protected, said the Welsh Government.

Minister for finance and local government, Rebecca Evans, said, however, that this money has had to come mostly from diversions out of other budgets.

Other budgets, including notably the climate change one, have had money diverted away from them or planned rises scrapped.

Despite the additonal money for health and care, Ms Evans said health board and council leaders “will face some challenging decisions” to balance the books.

Funding for some substance misuse programmes, such as one which provided schools support to teach about the topic, has been cut.

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Health prevention policies for smoking cessation and obesity have had their spending reduced by £3m.

And while a protected pot of money for mental health services in NHS Wales will be retained, a planned £15m increase in funding has been scrapped.

Overall, the central mental health budget has been reduced by £6m for 2024-25.

Health protection budgets, which safeguard the public from health threats, were ‘reprioritised’ to the sum of £22m.

As well as this, the government has not ruled out increasing charges for services such as dental care and domiciliary care, and upping tuition fees, to bring in more money.

“If we decide to increase charges, proposals will be brought forward for consultation,” the budget said.

It continued: “All decisions by health boards will be subject to equality impact assessments, balance of risk judgements and potential consultations if decisions will lead to service change.

“Each health board faces different challenges in terms of population need and the configuration of services; the actions taken to manage any cost pressures will vary according to organisation and will be subject to local determination.”

Meanwhile, in social care, £11m has been diverted from the Social Care Workforce Grant which, the government admitted, would have “impacts” on local authorities and their associated social care providers.

Ms Evans blamed the cuts her government has had to make on the central UK Government; it provides the bulk of devolution spending via a block grant which, Ms Evans claimed, has declined in value in real terms by £1.3bn since 2021.

She said the global impact of Covid-19, wars in Ukraine and the Middle East, cost-of-living rises and high inflation had combined to make this the toughest year to govern in the devolved government’s history.

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“In making this draft budget, we have had to take incredibly difficult decisions – the starkest and most painful since devolution,” she added.

“This has not been a typical year, where we have had an abundance of positive choices to make about where we can target increased and additional investment.”

“Prioritising having enough nursing staff to care for patients safely is a wise investment”

Helen Whyley

On the NHS, Ms Evans said: “We expect the financial outlook for the NHS next year to be one of the most challenging we have ever faced.

“This additional funding will help to mitigate the more serious impacts on frontline services, patient care, access and performance targets.

“By investing more in the NHS we aim to offset the most severe impacts across all parts of Wales and provide protection for everyone, including children, disabled, older and vulnerable people.”

This budget comes just months after an ominous message to nurses by Welsh health and social services secretary Eluned Morgan at a conference held by the country’s national chief nursing officer (CNO).

At this conference, Ms Morgan warned budgetary pressures from Westminster could have a knock-on effect on the NHS.

However, Wales CNO Sue Tranka told Nursing Times at the time that she was optimistic for the future of the profession, despite its significant workforce challenges.

Royal College of Nursing (RCN) Wales director Helen Whyley said the government needed to put nursing and patient safety at the centre of its budget decisions going forward.

“Prioritising having enough nursing staff to care for patients safely is a wise investment,” she said.

“High quality care saves money as it reduces length of stays and improves patient outcomes in all settings.

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“A healthy Wales is a prosperous Wales. The people of Wales deserve that.”

The Scottish Government also announced an increase in health spending.

Deputy first minister and Scottish cabinet secretary for finance, Shona Robison, announced an increase in health and social care spending from £18.92bn up to £19.5bn, of which £13.2bn is allocated to Scottish NHS boards.

Budgets for mental health, public health and most other aspect of the health and social care portfolio have all been increased.

To fund this, with Scotland’s UK block grant having also decreased in value, Ms Robison also announced an increase in income tax for the top earners – as well as cutting funding for many other budgets.

Ms Robison added: “This budget is set in turbulent circumstances.

“At the global level the impacts of inflation, the war in Ukraine, and the after-effects of the pandemic continue to create instability.

“In the UK the combined effects of Brexit and disastrous Westminster policies mean that we are uniquely vulnerable to these international shocks.

“We cannot mitigate every cut made by the UK Government. But through the choices we have made, we have been true to our values and rigorous in prioritising our investment where it will have the most impact.”

Analysing the budgets, David Phillips, associate director of the Institute of Fiscal Studies, said that, where the Welsh budget prioritised the NHS “to the exclusion of almost every other area of spending”, the rises in Scotland were more modest.

However, Mr Phillips said it would “not be unexpected” if further NHS funding was announced during 2024.

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