Dilnot review to open NHS funding row David Cameron, prime minister, will fight the next election promising real-terms increases for the NHS, both health and Conservative party officials believe. But the health service is braced to resist demands that its budget should be raided to fund the £2.2bn annual cost of implementing a radical overhaul of social care, proposed by the economist Andrew Dilnot in a government-commissioned review. The coalition will this week unveil a white paper on social care for elderly and disabled people which will endorse in principle the idea of capping the amount individuals have to pay from their own pockets, with the state picking up the remainder, and introducing a more generous means-tested system. However, an accompanying "progress report" will make clear that no decisions have been reached on funding. Health service planners are working on the assumption that the coalition parties will go to the polls in 2015 promising to at least maintain the NHS budget in real terms - the same formula the prime minister used at the last election. But some in the health service believe the Treasury may press for the costs of the Dilnot blueprint to be met from the health budget, threatening a real-terms cut for the first time since the 1950s. The Dilnot proposals will form a central part of the next spending review, which will become a key political battleground in 2013. Final decisions are expected to be announced in next year's autumn statement after George Osborne, chancellor, put the brakes on the Dilnot exercise, telling colleagues: "I think I have a right to know where the money is coming from." Treasury aides yesterday dismissed the idea that health would get a real-terms increase, from which Dilnot would be funded, as "hypothetical" and "without foundation," pointing out that the spending review had yet to get under way. A decision once again to protect the health budget would cause consternation elsewhere in Whitehall as other departments contemplate further years of below inflation increases. However if the money must be found from the health budget, the impact on the health service, already struggling to cope with the burden of an ageing population and technological change, would be significant. Crucially, spending decisions agreed by the coalition will probably span the four years either side of the planned 2015 election and will therefore shape the way the Tories and Lib Dems fight that contest. A promise to increase NHS spending in real terms is seen by Tory strategists as essential in minimising the party's traditional weakness on health issues. However Labour could claim the Tories were planning real cuts to the health budget, if the Dilnot costs were included even in an increased settlement. If George Osborne looks to the health budget for the cash required to enact the recommendations of the Dilnot review, the impact would be substantial, according to calculations by the Nuffield Trust for the FT, writes Sarah Neville. It examined the effects of implementing Mr Dilnot's central recommendation for a £35,000 cap on the amount individuals have to contribute to their own nursing home fees, and a rise in the means-tested threshold from £23,250 to £100,000. Nuffield concluded that the health budget would face a real terms cut of 2 per cent - equivalent to the £2.2bn cost of Dilnot at 2010-11 prices - if headline NHS funding were maintained at the current level in real terms. This means the health budget would need to grow on average by 2.3 per cent for the three years from 2014 to enjoy a real terms increase, implying a rise of just 0.6 per cent a year for other departments.