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Should the chancellor of the exchequer lift the ringfence on England’s health budget?

BMJ 2013; 346 doi: (Published 26 June 2013) Cite this as: BMJ 2013;346:f4126
  1. Thomas Cawston, research director1,
  2. Alan Maynard, professor 2
  1. 1Reform, London, UK
  2. 2University of York, York, UK
  1. Correspondence to: Thomas Cawston thomas.cawston{at}, Alan Maynard alan.maynard{at}

Thomas Cawston argues that ring fencing NHS funding has failed to produce the necessary increase in efficiency and that more drastic cuts may be needed, but Alan Maynard says that this approach is more likely to make the situation worse

Yes—Thomas Cawston

Leaders from within the NHS, patient charities, academics, and policy makers recognise the need to change how health and care are organised and delivered.1 The objective of the NHS has changed, moving from providing episodic treatment for patients in hospitals to improving the quality of life for patients with chronic conditions. To meet this challenge support is growing for a model of care that offers more services in the community, focuses on prevention as much as cure, and cooperates effectively with social care.

However, since the UK general election in 2010 there has been no discernible shift in resources away from hospitals; the best available data show that general and acute services still receive over 40% of commissioner allocations.2 Spending on hospital services has increased by £1.3bn (€1.5bn; $2bn) since 2010 in real terms. The proportion of spending on primary care, learning disability, and mental health services has either fallen or stayed the same. In recent years more patients who needed urgent care had used alternatives to emergency departments, but since 2010 this trend has stalled and indeed started to reverse. In the first three months of 2013 over 27 000 fewer people used other urgent care providers such as walk-in centres compared with the same period in 2011.

While there were 4000 fewer beds in the last quarter of 2012-13 compared with the same period in 2010-11, the NHS workforce fell by only 0.3% in the last year and the hospital workforce actually grew.

Many have advocated improved coordination between health and care but the most recent data …

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