£29bn Real Terms Increase in NHS Funding (2023-24 to 2028-29)
Commitment: Increase NHS resource funding by £29 billion in real terms (£53 billion in cash terms) from 2023-24 to 2028-29 — representing 3.0% average annual real terms growth.
Owner: HMT / DHSC
Target date: 2028-29 (Spending Review period)
Metric: NHS resource DEL (Departmental Expenditure Limit) in real terms.
Status: active
Context
The £29bn real terms increase is the largest settlement of any government department in the Spending Review 2025. It represents the government’s primary investment in NHS recovery from COVID-19 backlogs and long-term demand pressures from an ageing population.
The settlement covers:
- NHS England resource funding (hospital trusts, primary care, mental health, community services)
- Capital: separate NHS capital budget increasing by £2.3bn real terms by 2029-30
What the funding is expected to deliver
Key commitments attached to the settlement:
- dhsc-nhs-18-week-92pct — 92% of patients starting consultant-led treatment within 18 weeks by Parliament end
- 5.2 million additional appointments (Budget 2025)
- 250 Neighbourhood Health Centres
- NHS productivity improvement (5-7% productivity growth required for the settlement to deliver waiting time improvements)
Key risk: productivity dependency
The NHS waiting list target (dhsc-nhs-18-week-92pct) requires both additional funding AND NHS productivity improvement. Historical NHS productivity growth post-COVID has been below the rate required. If productivity grows at its recent pace, the 18-week target may not be achievable within the funding envelope.
Delivery history
- [October 2024] Budget: NHS capital boost £300m; first indication of settlement scale
- [June 2025] Spending Review: full £29bn real terms settlement confirmed; 3.0% average annual growth