Why do the NHS savings matter?


It is easy to be lulled into a false sense of security about NHS efficiency savings.

The doors to GP surgeries and hospitals remain open and, come what may, patients always seem to get treated - eventually.

In fact, the very term itself sounds rather innocuous.

But make no mistake: how the NHS fares in the next few years in achieving its £20bn target will go a long way to determining what sort of health service the country has in the future.

If it does not achieve what it needs to it will be patients who suffer.

The £20bn figure equates to a saving of about 4% a year until 2015. That is unprecedented for a health system.

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Despite the NAO [National Audit Office] calling it the first year of the savings, the health service has still had plenty of time to prepare for the savings drive”

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If the NHS does not become more productive it will simply have to cut what it does to cope with the rising demand from factors such as the ageing population and obesity.

And what is worrying about the National Audit Office (NAO) report - despite the praise for the good progress that has been made to date - is that there are signs this could be starting to happen.

The watchdog found evidence of rationing in areas such as cataract surgery. The tactic, which involves making patients wait until their eyesight deteriorates further before they get treatment, makes a huge difference to an individual's quality of life.

As does the trend - noticed by orthopaedic surgeons - of leaving patients in pain for longer before they are entitled to hip or knee replacements.

Public Accounts Committee chairman Margaret Hodge - like many monitoring what is happening - is worried about what lies ahead.

Responding to the NAO report, she urged the Department of Health to be careful that the efficiency drive did not lead to the NHS "shutting the door" on patients.

But what makes the watchdog's findings even more startling is that despite the NAO calling it the first year of the savings, the health service has still had plenty of time to prepare for the savings drive.

NHS chief executive Sir David Nicholson first proposed the target three years ago and told the NHS to start looking for them in 2010-11 - the last year in which it got a significant increase in its budget.

That is why inside the health service the alarm bells are ringing loud and clear.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 113.


    One problem, how long is a lifetime? Is it based on what the average life expectancy is now, or what it might be in 50 years time. To mitigate against the risks of ever-rising healthcare costs (due to better technology), the insurance premiums even for the young and healthy would need to be massive.

  • rate this

    Comment number 112.

    After more than a decade of real improvement in the NHS the government,at a stroke, are on the brink of setting us back more than a quarter of a century.Safe hands?I don't think so.

  • rate this

    Comment number 111.

    @Perpetual Sigh

    "Tony Blair, the biggest traiitor this country has seen" .... ???!!!

    You do know "The Ghost" is fiction, don't you?

  • rate this

    Comment number 110.

    Cameron lied, and should be criticised for such, but Blair's asinine PFI is the ultimate reason the NHS is haemorrhaging money to begin with. All the other complaints (health tourism, funding being spent on the wrong things, bureaucracy etc) are valid, but all would be manageable were it not for Tony Blair, the biggest traitor this country has ever seen.

  • rate this

    Comment number 109.

    Contact sports yes - pay premium,

    Insurance premiums would be paid over a life-time. Therefore the older you are the more you will have paid in. Obviously a change of this magnitude would require many many years to phase in.

    There would be a variety of policies available as there is now for life insurance.

    Genetic screening would have to be illegal.

  • rate this

    Comment number 108.


    How much do you think that insurance premiums are for the old, with or without a history of illness? How many exclusions in their policies do you think there would be?

    The old also don't generally pay tax or receive much income, so it would all be a huge cost to them.

    Should those with a genetic predisposition to illness also pay more? Should those who play contact sports?

  • rate this

    Comment number 107.

    Slow day at work? What is that then?

  • rate this

    Comment number 106.

    @ 101

    Your attempt at sarcasm rather affirms my point. In a private system the user pays for his/her risk. Why is that anti-social?

    How you arrive at an anti-altruistic conclusion by extrapolating on a random tangent is worthy of a prize. Applying the same logic we should be living in a society of samaritans and saints - which we are not last time I looked.

  • Comment number 105.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 104.


    I take the conspiracy theory implication as a compliment. However I can assure you there is none. They question is not one of cost effectiveness it is a question of who/where the funding should come from and the inherent unfairness of a system that discriminates against healthy people.

    @99 I cant see how a private system would penalise the elderly. They would pay in & insurance pay out

  • rate this

    Comment number 103.

    Patient is fine, no she didn't do anything to bring on her problems. Unless being old and having a heart attack out of the blue is a crime.
    I, like most NHS employees, long ago paid back in taxes anything the country paid for my training. What a lot of self righteous individuals there are. By the way the private sector does train. The two sectors can be mutually beneficial if it is done well.

  • rate this

    Comment number 102.

    As an NHS nurse I know patient care is affected. In my district nursing team we have lost 3 members this year, none have been replaced. We are swamped with the amount of referrals we receive. We work non stop throughout the day just to ensure patients receive the visits they need. How long can this last? The NHS cannot run on the goodwill of its staff for ever!

  • rate this

    Comment number 101.


    Why stop at smokers? What about people who injure themselves doing DIY? Why should I pay for that? What about sports injury's? Why do i care if someone jumps over a hurdle? Why should I pay for that?

    In fact why help anyone at all? If you fell over and injured yourself, why should I stop to help? I was looking where I was going.

    Your apparent utopia is in fact, hell on Earth.

  • rate this

    Comment number 100.

    dont think the nhs has much to worry about,frankly. this govts doing a good enough job in shrinking the ageing population with its cuts to welfare etc. know what i mean?

  • rate this

    Comment number 99.

    @96 Aliboon : valiant effort but I think there is little point in arguing with "Random16". So far they have offered no evidence to back their proposition re: the NHS's cost-effectiveness or otherwise. My thinking is they have an agenda here, which is a vested interest in private healthcare, or they are a plant on this thread to talk down the NHS, or both. What they are not is coherent or balanced.

  • rate this

    Comment number 98.

    The NHS doesn't spend more on those that drink and smoke (whom also pay duty on their vices, so put more into the NHS than they take out, on average). The biggest cost to the NHS is the elderly and the longer they live, the more they cost. Should we penalise the old because they have the bad manners to live a long time and not die young due to lung cancer or a fatal heart attack?

  • rate this

    Comment number 97.


    I have not suggested following anyone. I have suggested abolishing the NHS in favour of a privatised system.Whether another country has done this or not I don't know.

    What is odd about pointing out the unfairness of a system that spends more money on those who make unheathly lifestyle choices (smoking, drinking) while spending less on those who live healthily yet everyone pays the same?

  • rate this

    Comment number 96.


    You are making less and less sense. You don't care what other countries do, but want to follow their system (private healthcare)because you think that the NHS isn't cost effective. I think I deserve a £1Bn xmas bonus, doesn't mean that I do actually deserve it.

    Of course the least health benefit the most from the NHS, healthy people don't need the doctor. Very odd point.

  • rate this

    Comment number 95.

    18 Minutes ago
    just done a heart operation (coronary bypass) since last comment.
    hope that counts as reasonable use of NHS money.
    That is a good question?, Simple answer "Yes",
    It does open a moral "No" debate?
    - Was the patient predisposed to coronary problems?
    - Did life style choices increase the likelihood of coronary problems?

    Plus other equally contentious questions?

  • rate this

    Comment number 94.

    "What many forget is who paid for training and educating the doctors, nurses and other health professionals was it the private healthcare companies or was it the taxpayer and NHS?"

    Are you suggesting that anyone that went to further education financed from the public purse should work for the public sector & not for the private sector, is that not making them indenture servants?


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