The Government's spending review on 25th November 2015 set out spending plans to 2020 and gave NHS England an initial additional 3.8 billion real increase next year out of a total of 8 billion real increase over the four years to 2020/21. Nurses training bursaries have been replaced by student loans and public health funding will be cut by another 3.8% in real terms to 2020/21 on top of a recent 7% cut. The chief economist of the King's Fund, in a response to the spending review, notes that some of the 8 billion real increase will come from other parts of the health budget as mentioned above, and most of next year's increase will be taken up by existing provider deficits and a change in the NHS pension arrangements which comes in next year and increases contributions from most staff and from NHS employers. In the meantime demand will increase remorselessly as our elderly population increases and the public health measures on which the NHS five year plan was predicated are not carried out by the Government. 22 billion will have to be saved, an unprecedented task. Social care will have an increase of around 10% over this period with councils additionally able to levy a 2% additional council tax to pay for social care. However it is thought that this will still leave a shortfall of several billion pounds for social care. The King's Fund's independent Barker Commission looked to public health and social care funding of 11% of GDP by 2020/21 but it looks as if the outturn will actually be below 8% putting us out of the league of our European peers.