The Treasury’s Comprehensive Spending Review in November 2015 will set out public spending and deficit reduction plans for the four years up to 2020. It will include important decisions on the size and shape of many parts of Government, including the NHS, public health, clinical training and social care.
The Nuffield Trust’s representation looks at the pressures on NHS funding up to 2020, the scope for savings and efficiencies, and the difficult choices on funding facing policymakers.
Our briefing looks at the £8 billion in extra funding promised to the NHS by 2020. We conclude that while it is a generous settlement in the context of wider spending cuts, it will be outpaced by constantly rising health care costs and patient numbers, with a real struggle to maintain standards.
There are opportunities for greater efficiencies, for example the £5 billion identified by the Carter review. However, the NHS is reaching its limits on some factors that were vital to making savings in the past, such as curbs on pay and staff numbers. Radical changes to how care is delivered must also contribute to savings over this period. But they will cost before they save and require more engagement from clinicians and managerial time and attention.
Although finances must be kept under control, we warn short-term measures to exert ‘grip’ could backfire by leading to a more regulated, top-down NHS that puts money above quality of care and loses the capacity to innovate.
We express concern that other budgets held by the Department of Health may not be ring-fenced. Giving the NHS more money by cutting services it relies on, like training and public health, would be counterproductive. Equally, the funding squeeze on social care could put progress on prevention and co-ordinated care at risk.