The cut
“We will guarantee that health spending increases in real terms, in each year of the Parliament, while recognising the impact this decision will have on other departments”
Coalition agreement, May 2010
The coalition government’s promise to protect the NHS from deep public spending reductions doesn’t sound much like a cut. But in fact that commitment doesn’t mean the health service, and patients, won’t be affected. CutsCheck has found that many NHS trusts are already having to reduce spending. Trusts are cutting back on hip and knee replacements, IVF treatment and cataract surgery – and reducing staff.
The background
After the big increases in NHS funding over the last decade (six per cent a year in real terms, when inflation is taken into account), the coalition government’s pledge isn’t one that offers complete reassurance. John Appleby, chief economist at the King’s Fund think tank, expects spending increases of no more than one per cent a year, after inflation, during this parliament.
And as well as budgets no longer growing, the NHS has been told to make “efficiency savings” of up to £20bn by 2014.
The two-year pay freeze for those earning more than £21,000 will help to keep costs under control. But will the NHS be able to meet demand and improve quality of care?
The analysis
Primary care trusts, which provide GP services and commission hospital treatment on behalf of patients, spend 80 per cent of the NHS budget. CutsCheck has been looking at how they are cutting their costs.
IVF fertility treatment, provided to 40,000 couples a year in the UK, is one of the services being cut. This is despite guidance from the National Institute for Health and Clinical Excellence that eligible people should be offered up to three cycles of IVF – and Health Secretary Andrew Lansley’s belief “the NHS has a responsibility to provide fertility services”.
In Warrington, the PCT has decided to stop funding IVF, although it will review this decision in July 2011. It also plans to reduce the number of opthamology appointments it makes for cataract investigation because it says 40 per cent of these are unnecessary and don’t lead to treatment.
Bury PCT, which is spending £1.3m more than the £25.8m it receives in income every month, has also announced that it’s suspending IVF – along with varicose vein and cosmetic surgery and homeopathy. It’s also tightening the criteria for hip and knee replacements and cataract surgery. The trust plans to save £700,000 in management costs by not filling vacant posts.
South West Essex PCT says it needs to “decisively” reduce spending – and “regrettably, this will have a direct impact on some of our patients, staff and partners”. Over-spending has reached £3m a month, and the trust says it’s planning to make savings of £43m. Ninety management posts are going – a third of the trust’s commissioning staff – to save £3.2m.
IVF for non-cancer patients is being suspended, tonsil removal operations will no longer be carried out and “non-essential services such as baby massage or cookery classes” will be scrapped.
The trust is also warning that patients will have to “wait a little longer for their surgery”, while £1.7m will be saved by clamping down on the number of people it says are being unnecessarily referred for MRI and CT scans by their GPs.
Nottinghamshire County PCT is making £80m of “efficiency savings” over the next two years. Previously, some people have received tonsillectomies, surgery to relieve snoring and treatment for varicose veins on the NHS. The PCT is now telling GPs that this can’t continue, unless there are clear medical benefits.
Manchester PCT is looking to make savings of £14m by cutting the number of hospital referrals and providing GP services in accident and emergency departments.
It isn’t just PCTs feeling the pinch. So are hospital trusts.
Imperial is one of the biggest trusts in the country and includes St Mary’s, Charing Cross and Hammersmith hospitals in London. It says: “In line with all other trusts we are facing financial challenges linked largely to reduced income as a result of government plans to deliver healthcare in community rather than hospital settings.”
Its target is to make savings of £69m, from a turnover of £900m, by using fewer temporary and agency staff, “scrutinising any new appointments” and reducing overtime.
Nationally, waiting time targets – guaranteeing waits of no more than 18 weeks between GP referral and treatment – have been scrapped. John Appleby, from the King’s Fund, expects there to be a rise in the number of people waiting longer in future.
The verdict
Despite the government’s pledge to protect the NHS budget, no-one should be under any illusions that the health service will remain as well funded as it has been over the last decade.
Some trusts have already started making cuts and others will follow. Hip and knee replacements, IVF treatment and cataract surgery are the first services to be affected. This list can only grow longer.
CutsCheck is the little sister of the Channel 4 News FactCheck blog. We scrutinise public spending cuts and uncover the savings the government doesn’t want you to know about. We judge each cut by how much it will save and how many people it will affect. If you know of a cut we should check, email us at factcheck@channel4.com.
