Bim Afolami overstates NHS in England as a share of ‘everything the government spends’

As a percentage of everything the government spends, the NHS is about 42-43%. It’s a huge amount of all the money the government spends.

The Treasury minister Bim Afolami incorrectly claimed that the NHS accounts for about 42-43% of total government spending. This is a common mistake, which some social media users noticed, and which we have fact checked before.

Mr Afolami’s figure seems to refer to the proportion of budgeted day-to-day spending, as set out in Departmental Expenditure Limits, also known as Resource DEL—but this only accounts for just over a third of public spending as a whole.

The rest is capital spending (for instance on building new hospitals and roads) and, largest of all, Annually Managed Expenditure, or AME, which is mostly made up of benefit payments. AME is different, because it is not set by government budgets but by demand.

Together, AME and the two categories of budgeted spending make up Total Managed Expenditure (TME), which is more accurately “everything the government spends”.

In 2023/4, the Treasury estimates that £174.6 billion will be spent on health and social care in day-to-day spending. Of that, around £161.1 billion will be spent on NHS England. In addition to this, there will be £12.1 billion of capital spending on health and social care. (Health is devolved so the UK government is only responsible for health services in England.)

Taken together, these represent about 41% of the total Resource DEL of £456.4 billion, including some health spending that does not go to NHS England.

But with total managed expenditure being £1,222.3 billion, health spending actually amounts to about 14-15% of “all the money the government spends” (depending on whether you include the non-NHS health spending).

NHS industrial disputes

Later, talking about industrial disputes in the NHS, Mr Afolami also said “As a government… we’ve settled with consultants, nurses, all sorts of other medical staff.” [41:30]

This is misleading. As we’ve said before in relation to comments made by Rishi Sunak, consultants and specialty/specialist doctors in particular have not yet confirmed that their strikes are over.

Indeed on 15 January, three days before Mr Afolami made his comments, the Hospital Consultants and Specialists Association (HCSA) union voted to reject the government’s latest pay offer. Consultants in the BMA union also voted to reject the pay offer, with the result being announced on 25 January.

Strikes by nurses ended last June after a ballot of RCN members did not achieve a mandate for more strike action. This means its members cannot strike again and the Royal College of Nursing has said they will not be balloted again about pay in 2022/23 or 2023/24.

In effect this seems to mean that the nursing strikes are over for now, although whether this means the dispute is “settled” is probably a matter of opinion.

Politicians, and ministers in particular, should take care to be accurate when talking about public finances, or public services, so that people are not misled about the government’s performance.

Full Fact has contacted Mr Afolami about both of these claims and will update this article if we receive a response.

Image courtesy of Chris McAndrew