Feature Health Economics

Where do the cuts leave the NHS?

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6024 (Published 26 October 2010) Cite this as: BMJ 2010;341:c6024
  1. Nick Timmins, public policy editor, Financial Times
  1. Nick.Timmins{at}FT.com

The UK’s coalition government has honoured its promise to give the NHS an increase in real terms. But the rise—0.1% a year until 2014—could not have been smaller, reports Nick Timmins, and will leave the service struggling to meet rising demand, while cuts elsewhere could leave healthcare workers to pick up the pieces

It was, you might say, exactly as expected. The coalition government has honoured, to the letter, its promise to provide the National Health Service with real terms growth over the next four years. But only to the letter. And for the health service, the next four years will be anything but business as usual.

At no point in the memory of anyone working in the NHS will the service have faced such a prolonged and sustained spending squeeze. Not since the 1950s—between April 1951 and March 1956—has it received such a small increase, according to the Institute for Fiscal Studies. And back then, while it was coping with the effects of the long postwarbaby boom, it was not facing such a rapid rise in the numbers of older people. Nor were there such pressures from the costs of medical advance, although (in pharmaceuticals particularly) those pressures were beginning to be felt.

The NHS has been relatively protected against the spectacular cuts being imposed in other areas—23% reductions for the Home Office and Ministry of Justice, 26% for local government, larger still for new social housing. But the crucial word there is “relatively.”

The comprehensive spending review, based on the government’s own figures, delivered a rise in NHS spending in England after economy wide inflation—in other words a real terms increase—of 0.1% a year until 2014. That figure is made up of a real terms rise of 1.3% over the period in current expenditure but a 17% cut …

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