The amount the NHS spends per patient would fall between £98 and £191 – a real term drop in spending of at least £5.5bn – by 2020 under the main political parties’ funding pledges, analysis reveals.

The figures, based on NHS England’s own calculations, show that despite the ringfence applied to the service’s budget, spending – using health officials’ preferred measure of estimated patient numbers – has fallen £50 per patient since 2009.

Under the Conservative party’s pledge to hold NHS spending in line with inflation, the fall per patient would be £191 from 2009 to 2020 – about the cost of one accident and emergency visit for a patient in England.

Under the Liberal Democrats, funding would fall £174 per patient during the same period, while under Labour’s pledge it would fall £98 – about the cost of an outpatient appointment.

The Financial Times worked on the figures with the health policy think tank, the Nuffield Trust.

Senior NHS officials warned the government last month that the UK’s ageing population meant simply “protecting” NHS funding from inflation would quickly lead to cuts in services and care quality.

Nigel Edwards, chief executive of The Nuffield Trust, said the analysis would make uncomfortable reading for the main political parties who have all based their NHS funding pledges on the much lower increases implied by growth in gross domestic product.

“They are happy to quote those numbers but without a context,” Mr Edwards said, “and without suggesting there is a fundamental pressure created by population changes and size.”

NHS England said: “We know we need to get more serious about prevention and modernise the way we provide care, applying [more effective] care models.” But, it added, to remain sustainable, the service would need funding increases “close to flat real [terms]” per patient – adjusted for the additional cost of age.

The UK’s population of those aged 65 and over is projected to increase more than 50 per cent over the next two decades with the number of over-80s expected almost to double.

NHS England’s calculations break down how much the NHS spends on patients across 18 age categories. These show that those aged 60 to 64 cost the NHS twice as much as those aged 40 to 44, while those aged 85 and above cost about 10 times as much. NHS England has used these calculations to estimate how many patients will need treatment, as the number of people in the older categories swells.

The Nuffield Trust replicated these calculations to analyse how NHS funding for each of these patient groups has changed since 2005 – the earliest year for which comparable data were available – and how much it would change under each of the parties’ funding pledges.

The analysis shows a rapid increase in per patient spending under the last government, rising from £1,790 in 2005 to £2,021 in 2009. Spending per patient then fell sharply from 2010 onwards and will next year be only marginally higher, in today’s money, to spending in 2008, illustrating how the NHS will struggle to keep up with innovations in healthcare and pharmaceutical costs.

Under all three parties’ pledges, per patient spending is set to be lower in 2020 than it was in 2007.

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