Intended for healthcare professionals

Observations On the Contrary

What to cut

BMJ 2009; 338 doi: (Published 07 April 2009) Cite this as: BMJ 2009;338:b1457
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

    After the years of plenty the NHS will have to tighten its belt

    In the first decade of the Labour government, spending on the NHS rose at an annual rate of 6.1%. This year and next it will rise at 5.5%, unless the current financial storm blows this commitment off course. From April 2011, spending will rise at 1%, if at all. This means that the NHS has two years to tighten its belt. I learnt all this at a recent health strategy summit organised by the Nuffield Foundation, which got me thinking about ways to save money. Here’s my top 10.

    1. Stop expanding capacity needlessly

    As Jo Ellins and colleagues pointed out in their recent article on the primary care market, “spare capacity and instability [in the NHS] may be necessary to create the conditions for choice and competition” (BMJ 2009;338;b1127, doi:10.1136/bmj.b1127). The independent sector treatment centres, liberalisation of the primary care market, and the polyclinics mooted by the health minister Ara Darzi were intended to produce both. Yet patients’ appetite for choice is minimal, as last year’s joint report from the Healthcare …

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