- The health department’s budget for this year is around £184m lower than the amount spent by the department last year – but, this is not comparing like with like.
- Instead, Stormont’s 2024-25 budget actually handed the DoH around half a billion pounds more than its 2023-24 equivalent.
- The difference between initial budget and final expenditure comes from the extra cash that can be distributed to departments during a fiscal year. Last year, DoH received hundreds of millions of pounds from in-year “monitoring rounds”. As of the time of publishing, the Department of Health was allocated an extra £122m.
In its manifesto for the 2024 Westminster election, the UUP claimed: “Instead of investing in our health service, the 2024/25 Budget is delivering a record £184m cut in funding.”
This is a complicated claim to dissect.
The Department of Health’s recently-announced budget for this year (2024-25) is actually hundreds of millions of pounds higher than its initial budget allocation for 2023-24.
However, the allocation in the 2024-25 budget is around £184m lower than the department’s final expenditure last year. However, comparing one year’s budget with the previous year’s expenditure is not a like-for-like comparison.
Due to extra budget allocations being made during the financial year, it’s not unusual for a government department’s total spending at the end of a year to be higher than its initial budget. Last year, the Department of Health received hundreds of millions of pounds in extra finance, on top of its starter budget. Indeed, at the time of publishing this article, a Stormont “mini budget” allocated the Department of Health an extra £122m.
For a fuller understanding, read on.
- Response
FactCheckNI contacted the UUP to ask about this claim. At the time of writing, we haven’t received a reply.
- What does health mean?
The claim says funding for the “health service” has been cut.
The health service and the Department of Health (DoH) are not precisely the same thing but, for the purposes of this check, we are using the DoH’s budget as a proxy for the health service budget.
The DoH has three main areas of responsibility: Health and Social Care (HSC); Public Health; and Public Safety (which includes NI Fire & Rescue Service). And other departments fund schemes that link into “health” initiatives, such as the role education plays in improving mental health.
However, the vast majority of the overall health budget comes from the DoH and the vast majority of the department’s budget goes into the health service – or, more accurately, our integrated Health and Social Care service (which itself can colloquially be described as the “health service”).
Finally, Stormont’s 2024-25 budget is (largely) composed of allocations to individual departments, rather than to specific services, and it is up to departmental ministers to spend that money as they see fit. This is the kind of budget that the claim refers to.
There can be additions to the budget, through what are termed “monitoring rounds”. Indeed, at the time of publishing this article, a Stormont “mini budget” allocated the Department of Health an extra £122m.
- Budget rising, not falling?
The allocation announced by the Minister of Finance to the Department of Health for the 2024/5 financial year – albeit announced several weeks into the Financial Year on 25 April – was £7.7160bn in resource DEL (Department Expenditure Limits) excluding earmarked items.
The directly equivalent figure (information provided in the same document) for 2023/4 was £7.2612bn, meaning that the budget has like-for-like increased by £454.8m, or 6.26%.
So, where could any idea of a cut come from?
- In-year money
Government departments get handed an allocation during a budget – but that’s not the end of the story.
During the financial year, it is common for extra money to be made available by other NI Departments (when it turns out it cannot be spent on the original purpose) or by the UK Treasury, typically because money has been re-allocated or brought in through other revenue or borrowing (extra allocations known as “Barnett Consequentials”).
Reallocations such as these occur every few months and are known collectively as “in-year monitoring rounds”.
This is important because there is a way to argue that health has received an £184m cut, but only by comparing two different things.
- Budget vs expenditure
The result of extra in-year allocations is that there is normally a difference between the budget handed to a department at the outset of a year and what it actually spends in total over the course of that year.
As noted by the Healthcare Finance Management Association (HFMA, the professional institute for healthcare finance) the budget allocation for 2024/5 represents – in the HFMA’s words – “a 2.3% reduction in funding compared with expenditure in 2023/24” of around £184m.
The UUP’s manifesto does not make this distinction clear.
The issue is that this is not comparing like with like. The HFMA statement goes on to explain that “the Budget in fact awards an additional £515m” compared to 2023-24.
- What’s the verdict?
- It is accurate to say that the Department of Health has been handed a budget totalling around £184m less than it spent last year.
- But it is not accurate to say that its budget has been cut when it has increased by around £450m.
By using the simple language “cut in funding” but offering no qualification to highlight that one year’s spending is being compared with the next year’s initial budget (that always increased with in-year allocations) – and ignoring the like-for-like increase in initial budget, we are rating this claim a rating of INACCURATE WITH CONSIDERATION.
To properly understand this claim, it is important to know how the two statements above are true and to know how the relationship between them works.
FactCheckNI would always say that fact checks should be read and understood as a single piece of work, and the rating is never the whole story. However, hopefully if you’ve read this far you feel more informed.
- Wider debate
This idea of an £184m cut to health was brought up during the Northern Ireland leaders’ debate on the BBC on June 27, with the leaders of both the DUP and the Alliance Party both taking issue with the budgetary position being framed in that way.
Health has been an important political and policy issue in Northern Ireland for years. Rising demand continues to increase pressure on services.
Ultimately, the UUP is making a point about the state of the health services and the financial commitments required to fulfil those. Arguing about the distinctions between an initial budget and final expenditure has almost nothing to do with that – and any such arguments could have been avoided with a bit more clarity of message.
Regardless, none of that will provide an answer to the questions of whether health funding is sufficient and whether the money available is being spent well.
