What’s happening to NHS spending across the UK?BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2982 (Published 24 May 2011) Cite this as: BMJ 2011;342:d2982
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Whilst I have the utmost respect for John Appleby as a health
economist, and for the Kings fund as an independent organisation I must
take issue with his latest analysis. Not only were the original figures
inaccurate in suggesting that Wales was facing a 10.7% cut in funding over
the forthcoming 3 years (he originally also incorrectly calculated the
figures over a 4 year period despite the Welsh Government budget being a 3
year cycle), he also fails to mention the disproportionate amount that
Health spending represents over 40% in the Welsh Government budget
received from the UK Government. The actual real-terms cut in funding is a
drop of near 8.3% which while still a substantial amount, also shows how
the Welsh administration has taken the difficult decision to "spread the
pain" of the cuts inflicted by Westminster. Without maintaining sensible
levels of funding for education, social services, housing and culture, the
overall health of the Welsh people is likely to decline even further, from
its current poor status. without this investment bed blocking, risky
health behaviour and poor living environments are likely to exacerbate the
demands on front line services and push the Welsh NHS to breaking point,
or beyond. His error, be it a "spreadsheet error" or merely carelessness
on his part led to inflammatory scaremongering headlines in several Welsh
based papers including one headline "National Horror Service". As a junior
doctor who is passionate about the NHS, and serving the Welsh Public not
only do I find this headline insulting to the effort and hard work that my
colleagues and I put into our jobs, but it also gives the public the
misperception they are somehow second rate citizens. One thing I am
grateful for is despite the lack of funding the Welsh Government is
committed to maintaining and improving the NHS in Wales. Something that
the UK Government cannot claim to be doing with it's Health Reforms!
Competing interests: No competing interests
Appleby's data indicate Welsh spending per head of population is and
has been higher than that in England in the recent past.
However it is not clear whether the spending has been adjusted for
The population in Wales is older and has a higher health needs. (1)
In primary care these are the two most important determinants of the Carr-
Hill Allocation Formula. Primary care in Wales already receives 9% less
money than the English equivalent. Figures on total health spending per
capita may not represent the degree of health poverty in the respective
parts of the kingdom.
(1) Rhys G, Beerstecher HJ, Morgan CL.
Primary care capitation payments in the UK. An observational study.
BMC Health Serv Res. 2010 Jun 8;10:156
Competing interests: co-author of quoted article.