Fund extra NHS appointments: note

Central fiscal result

+£1.1bn - Net fiscal impact in 2028-29

Low case: +£0.7bn. High case: +£2.5bn. Positive numbers are fiscal costs or borrowing pressure. Negative numbers are Exchequer savings or receipts.

Scenario and baseline

• Models fund extra nhs appointments 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 +£1.1bn 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: +£1.3bn
• Tax and receipt offsets: -£0.1bn
• Administration and evaluation: +£0.1bn
• Behavioural and pass-through effects: -£0.2bn

Central net impact: +£1.1bn 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: +£0.1bn. Phased implementation and take-up.
• 2027-28: +£0.6bn. Phased implementation and take-up.
• 2028-29: +£1.1bn. Phased implementation and take-up.
• 2029-30: +£1.1bn. 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.
• HM Government, "Plan for Change" (2024): The plan sets measurable targets on homes, health, police, school readiness and clean power; used for current government delivery targets.
• 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.
• HM Treasury, "Spending Review 2025" (2025): The review sets departmental spending plans across health, defence, housing, schools and transport; provides implementation and budget context.
• Labour Party, "Change: Labour Party Manifesto 2024" (2024): The manifesto sets the policy pledge, funding claim or target being modelled; used as the policy definition and manifesto baseline.