Westminster does not control the amount Scotland spends on its NHS

A post on Twitter which has also been shared on Facebook claims that the UK Government controls how much the Scottish Government spends on its National Health Service. 

The post states: “DON’T BE CONNED. Scotland’s NHS budget is DEPENDENT on what the British Government allocates to England’s NHS. The more they run down NHS England for MORE privatisation. The LESS is allocated to Scotland as consequential. The British Gov. IS STILL IN CONTROL OF NHS SCOTLAND! [sic]”

This is not completely accurate. Although a reduction in health spending in England would reduce the overall size of the grant Scotland receives from the UK Government, following devolution in 1999 the Scottish Government has had control over how much of its overall budget for public services it spends on the NHS in Scotland. 

Scottish funding

Funding for the Scottish Government comes from a combination of devolved tax revenues (like income tax) and limited borrowing, along with an annual “block grant” from the UK Government. 

Changes to the size of the block grant is determined by a system known as the Barnett formula which was introduced in 1979 to determine the level of UK Government spending on public services distributed to Scotland, Wales and Northern Ireland. 

The formula works by increasing the amount given to devolved governments when the UK Government decides to increase spending on services that don’t affect the whole of the UK, on a population basis. 

Health is a devolved policy area. If the UK Government increased its total health spending in England by £100 million, the block grant for Scotland would increase by about £9.7 million, because Scotland’s population is about 9.7% that of England’s.This money is known as a Barnett consequential, as referenced in the social media posts.

However, devolved governments don’t have to allocate their spending in the same way as the UK Government does in England.

So while it’s correct that reductions in health spending in England would reduce the overall size of the block grant, it's up to the Scottish Government to decide whether it would also reduce health spending or spending in other areas. 

Further evidence that the Scottish NHS budget is under the control of the Scottish Government can be found in the SNP 2021 manifesto in which the party promised to boost NHS funding by an amount higher than that being provided by the Barnett consequential for frontline health spending. 

And in actual fact, the amount spent on health and social care in England has increased in real terms, not decreased, in recent years, meaning the Barnett consequential for Scotland resulting from health and social care spending in England has also increased. 

How much does Scotland spend on healthcare?

As of 2021/22, overall public spending was 20% higher for Scotland, at £13,881 per person, than for England. This includes money spent by Scottish authorities as well as by the UK Government for Scotland. 

However, the Institute for Fiscal Studies (IFS) found the gap between the amount spent on health specifically per person in Scotland and in England has fallen sharply in recent years. In 1999/2000 spending on health per person in Scotland was 22% higher than in England but by 2019/20, this difference had fallen to 3%. 

The IFS said NHS spending had been “prioritised to a lesser extent” in Scotland, saying “this may reflect a growing share of the health portfolio’s budget going to early years and adult social care services”.

Image courtesy of Tommao Wang