Add £20bn NHS capital: note

Central fiscal result

+£4.0bn - Net fiscal impact in 2028-29

Low case: +£3.0bn. High case: +£9.0bn. Positive numbers are fiscal costs or borrowing pressure. Negative numbers are Exchequer savings or receipts.

Scenario and baseline

• Models add £20bn nhs capital by 2028-29.
• Baseline is current policy or published departmental plans.
• Central case uses published party or official anchors where available.
• Wider manifesto interactions are excluded unless stated.

Affected population

• Affected units are people, firms, households or providers depending on policy.
• Direct exposure follows the manifesto or government target group.
• Indirect exposure includes suppliers, workers, consumers and taxpayers.
• Weakest counts are widened in the low and high cases.

Gross impact

• Published anchor or scenario central is +£4.0bn in 2028-29.
• Gross costs or receipts are adjusted for behaviour and delivery risk.
• Tax, benefit or procurement offsets are separated in the fiscal build-up.
• The range is deliberately wider where implementation detail is thin.

Fiscal build-up, central case

• Gross programme or delivery cost: +£4.6bn
• Tax and receipt offsets: -£0.3bn
• Administration and evaluation: +£0.1bn
• Behavioural and pass-through effects: -£0.4bn

Central net impact: +£4.0bn in 2028-29.

Behaviour and pass-through

• Low case assumes stronger delivery or receipts than central.
• Central case applies moderate behavioural leakage and pass-through.
• High case allows weaker delivery, larger take-up or higher costs.
• Output effects follow incidence, capacity and investment channels.
• Distributional gains do not automatically imply GDP gains.

Phasing

• 2026-27: +£0.4bn. Phased implementation and take-up.
• 2027-28: +£2.2bn. Phased implementation and take-up.
• 2028-29: +£4.0bn. Phased implementation and take-up.
• 2029-30: +£4.0bn. Phased implementation and take-up.

Main source groups

• Cooper, Gibbons, Jones and McGuire, "Does Hospital Competition Save Lives?" (Economic Journal, 2011): Hospital competition under fixed prices was associated with lower mortality in some settings; shows that NHS productivity depends on institutional design.
• Institute for Fiscal Studies, "Green Party manifesto: a reaction" (2024): Used to define the pledge wording, policy scope and implementation scenario being modelled.
• Local Government Association, "Green Party manifesto summary" (2024): Used to define the pledge wording, policy scope and implementation scenario being modelled.
• Propper, Burgess and Gossage, "Competition and Quality in the NHS" (Economic Journal, 2008): Healthcare quality responds to incentives, but design can create unintended trade-offs; relevant to elective-care delivery incentives.
• NHS England, "NHS priorities and operational planning guidance" (2025): NHS guidance identifies capacity, waiting-list, workforce and productivity constraints across services; extra funding may not translate quickly into output.
• HM Treasury, "Spending Review 2025" (2025): Spending Review settlements define the public-spending counterfactual for health budgets; used to distinguish new funding from baseline growth.
• Green Party of England and Wales, "Manifesto for a Fairer, Greener Country" (2024): The manifesto defines the tax, spending, climate, housing and public-service proposals modelled here; used to define the scenario, not as an official costing.