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The 2009 budget and the NHS

BMJ 2009; 338 doi: (Published 29 April 2009) Cite this as: BMJ 2009;338:b1760
  1. Chris Ham, professor of health policy and management
  1. 1Policy and Management, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  1. c.j.ham{at}

Doctors need to be fully engaged in saving money and improving outcomes

Reassurances by ministers about the implications of the 2009 budget for NHS spending should not mask the reality that funding will become much tighter. The first effects will be felt in 2010-1, when the NHS will need to contribute £2.3bn (€2.6bn; $3.4bn) of the £5bn of public sector efficiency savings being sought that year. Thereafter, the likelihood is of real and substantial cuts as the government takes steps to deal with the effects of the recession and the banking crisis, a prospect that is much worse than seemed likely even in the autumn.1

An analysis by the Institute for Fiscal Studies indicates that a plausible scenario is real reductions in spending in all government departments except for international development, perhaps of about 2%.2 These cuts will last at least until 2014, and they could extend over a longer period, depending on the accuracy of the chancellor’s assumptions on economic growth. The 2009 budget therefore signals the beginning of a sustained period of disinvestment in the NHS, a mirror image of Tony Blair’s commitment in 2000 to increase healthcare spending to bring it in line with the European Union average.

In anticipation of tough times ahead, the Treasury has undertaken reviews …

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