What is the Spending Review (SR)?
The SR is a process where the Chancellor of the Exchequer sets out public spending plans, typically to cover multiple years. It determines how government departments allocate their budgets, shaping priorities for public services, infrastructure and welfare.
The 2025 SR will be particularly significant, as it will influence long-term funding for key areas like health care, education and defence. This SR will cover 2026/27, 2027/28 and 2028/29.
While the initial decisions of the SR will directly impact England's spending, the overall level of spending across all public services will influence the block grants received by devolved administrations in Wales, Scotland, and Northern Ireland. These devolved administrations will then make their own decisions on spending within their areas based on their allocated block grants.
What is the process?
The Chancellor of the Exchequer and Chief Secretary to the Treasury lead the SR. The government identifies key priorities for its departments.
Then, departments submit spending plans to meet government aims, which Treasury officials review to ensure alignment with national goals and value for taxpayers.
The Chief Secretary then negotiates final budgets with ministers before the Chancellor approves and allocates funding.
There is also an opportunity for outside organisations, like the RCN, to feed into what we think the government should prioritise its spending on. We’ve submitted evidence as part of this process, setting out our key concerns and expectations for future funding decisions.
What are we asking for in our submission?
The SR is an opportunity to start addressing some of the challenges within the nursing workforce and wider health and care system. We’re asking that the 10-Year Health Plan and the forthcoming Workforce Plan for England, and the SR are aligned in terms of funding, ambition and planning.
Our submission states: “Too often we have observed national plans for the NHS fail to be underpinned by sufficient funding, and workforce plans which do not support delivery.”
Here’s what else we’re asking for.
- Provide sufficient long-term funding to support the delivery of the workforce plan refresh – this must cover the costs of the additional salaries of new and additional nursing staff and the costs of expanding training places.
- Introduce loan forgiveness for nursing graduates.
- Invest in the community nursing workforce to enable the shift from acute to community, and from sickness to prevention. Without a fully funded staffing model, any plans to deliver more care in the community will fail.
- Provide financial subsidies to higher education and further education institutions to protect all nursing courses and ensure that they can continue to deliver, particularly given the muti-year focus of this SR.
- Urgently invest to address the NHS maintenance backlog and unlock additional clinical capacity and bed space. Nursing staff are far too often providing care in inappropriate settings, causing harm to patients and significant moral injury to health care workers.
- Provide a substantial, restorative pay rise for nursing, and central funding for professional development of band 5 registered nurses, utilising Annex 20 of Agenda for Change to enable them to progress to band 6 after a period of preceptorship.
- Remove the No Recourse to Public Funds condition on migrant workers on temporary visas. This is a key risk to the financial stability of internationally educated nurses and their families.
Why is this an important moment?
The nursing workforce is in crisis, with too few new recruits, and too many staff leaving before retirement. Workforce conditions are unsafe, pay is poor and demand is increasing. Throughout the system corridor care is rife, leading to moral injury for nursing staff while they provide care for patients without the dignity, privacy or resources they need.
Without a resolution to the nursing workforce crisis, it will be impossible for the government to successfully deliver on their three priority shifts – from hospital to community, sickness to prevention, analogue to digital.
This is a multi-year SR, meaning there is additional importance and impact resulting from decisions taken in this period. As this sets government spending plans for multiple years, if we don’t influence it now, we won’t be able to for another few years at least.
Nursing staff in every setting and level of seniority are critical to facilitating the type of transformation which is needed to make the health and care sector fit for the future.
Let’s talk more about the government’s priority to shift from hospital to the community. What have we identified as the issues blocking this?
We expect the forthcoming NHS 10-Year Health Plan in England to set out more detail on the shift from hospitals into the community. This should mean greater investment in the primary and community services that support people before they end up needing hospital treatment.
To successfully shift more care from hospitals to communities, the government must address key challenges, including staff shortages, underinvestment in facilities, and insufficient bed capacity.
In our submission, we said: “Governments should take steps to increase staffed bed capacity and expand community care provision so that patients can receive more care in appropriate community settings and be discharged when they are fit to be so. This is important given that the SR covers a number of years.”
Staff shortages across community and social care cause delays and blocks to patients being discharged into the community, leaving hospitals full and staff having to provide care in inappropriate settings, also referred to as corridor care. Shortages in specialist community roles, particularly health visiting and school nursing, also reduce opportunities for prevention.
We believe that community and district nurses are essential for expanding care in the community. Numbers of community nurses have held steady since 2016, while district nurse numbers have declined. With demand rising, urgent action is needed to recruit, support, and retain these members of the nursing profession, otherwise plans to shift more care away from hospitals won’t succeed.
What about the shift from analogue to digital?
Another one of the government’s shifts is transitioning/moving from analogue to digital. We believe digital transformation funding is needed within the education pathway.
"We’re clear that the quality standards must be set for simulated learning methods, and therefore the technology is likely to require significant national investment,” the submission said.
The cost to set up simulated learning environments is also significant, and we’re very concerned there is a lack of investment in the education workforce, who will be critical to successfully implementing these changes and interventions.
Significant increases in student numbers will require additional education staff, however, there is no recognition of this within the workforce plan. Likewise, there is no assessment of the impact upon the workforce which will occur when nurse educators are taken out of practice to deliver increased education capacity.
What do we need to do to meet the government’s aim of shifting from sickness to prevention?
Significant spending will be required to tackle the social determinants of health and halve the gap in healthy life expectancy between the richest and poorest regions in England.
We believe that addressing health inequalities must be a core priority for the government, with clear targets and actions, building on lessons from the existing NHS Long Term Plan, the COVID-19 pandemic, and other approaches to tackling inequalities.
“There must be a cross-departmental national strategy for improving health and reducing health inequalities, including action to address the wider determinants of health,” the submission said.
There is significant evidence of the benefits of investment in prevention and public health. A focus on prevention can support reduced rates of illness and premature mortality and a healthier population, which in turn contributes to reducing pressure on overstretched health and care treatment services and increases productivity and economic activity.
Further information
Read about campaigning with the RCN.
