Current NHS trust efficiencies are likely to dry up next year, experts say

BMJ 2011; 343 doi: (Published 19 September 2011) Cite this as: BMJ 2011;343:d5890
  1. Adrian O’Dowd
  1. 1London

Most NHS organisations in England will meet efficiency targets this year but will struggle to maintain that success next year and beyond, claim experts on health policy.

Witnesses appearing before the parliamentary health select committee on 13 September said they feared that efficiency savings being made this financial year would be extremely difficult to maintain from 2012-13 onwards.

MPs were quizzing witnesses as part of the committee’s first evidence session of its new inquiry into public expenditure.

The committee’s chairman, Stephen Dorrell, the Conservative MP for Charnwood, asked witnesses what progress they thought had been made so far on the government’s drive for the NHS to make £20bn (€23bn; $32bn) worth of efficiency savings by 2015.

Judith Smith, head of policy at the health think tank the Nuffield Trust, told the committee, “It’s clearly an unprecedented challenge that has been set for the NHS.

“We believe the health service is taking the challenge very seriously, but there is a sense that it is proving difficult and may well indeed get much more difficult as we move forward.”

A fellow witness, John Appleby, chief economist at the health think tank the King’s Fund, said, “One of the big problems . . . is actually knowing what is going on out there. There are no routine auditable data on efficiency savings.”

The King’s Fund had been collecting some data from NHS trusts’ finance directors to get an idea of the situation.

Mr Appleby said, “This year I think most organisations will just about scrape together the money and they’ll get through, and nationally the Department of Health will be able to claim that they have met the target.

“The real difficulty will come next year, and then it gets worse from then on.”

This, he said, was due to the fact that organisations had been relying on reserves to help them and cutting back on staff—two ways of making savings that could not continue year after year.

MPs asked whether the witnesses agreed with the health department’s opinion that the quality, innovation, productivity, and prevention (QUIPP) programme to encourage the NHS to deliver high quality care in a tighter economic climate was on track and that real savings were being made.

Mr Appleby replied: “One of our big worries is that we simply don’t know where the NHS is at the moment. I have my doubts even at the end of the year and beyond whether we will know whether the system has achieved what it set out to achieve.”

Mike Farrar, chief executive of the NHS Confederation, which represents NHS organisations, also giving evidence, said that the government’s expectations of the NHS to make efficiency savings were feasible, but with some caveats.

“It is deliverable but only if significant improvements are made in terms of the way that we are going about it at the moment,” said Mr Farrar.

“Individual organisations need to be as efficient as they possibly can and deliver savings within their boundaries. Care pathways need to be redesigned, and commissioners and providers need to work together to get the most effective use of resources. There also needs to be more intelligence of configuration of services.”

MPs asked whether Mr Farrar agreed with the BMA’s comment that the need for the NHS to find savings had compromised patients’ access to services and increased waiting times.

Mr Farrar replied: “I think it is inevitable that that has to be linked to a degree of financial pressure.”


Cite this as: BMJ 2011;343:d5890