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Cut NHS demand rather than ration, MPs say

Savings in the NHS are in danger of being achieved by rationing rather than through reducing the demand for health services, a Parliamentary committee warns.

A report by the Public Accounts Committee says savings of £5.8 billion were made in 2011-12, virtually all of that year’s forecast of £5.9 billion. The government expects that by the end of 2012-13 the savings made will total £12.4 billion, it says.

The Department of Health estimated that the NHS needs to make efficiency savings of up to £20 billion in the four years to 2014-15.

The NHS is seeking to make savings by reducing the demand for health services, particularly for acute hospital care. But the committee heard widespread concerns, from patient groups as well as professional bodies, that access to treatments such as cataract and bariatric surgery is being rationed.

The report says such treatments may be classed as of ‘low clinical value’ but they can make a real difference to a patient’s quality of life. Delaying treatment may also lead to greater cost in the longer term, it concludes.

“The NHS intends that the quality of healthcare should not suffer as it pursues efficiencies,” the report says. “While performance against a small number of headline indicators of quality, including waiting times and infection rates, was maintained in 2011-12, we are concerned that the need to make savings may be affecting wider areas of care quality, which are not adequately measured.”

It says most of the savings to date have been achieved through freezing the pay of NHS staff and reducing the prices paid for healthcare. The more challenging, and risky, part of the efficiency drive requires transformation in the way health services are actually provided. Over the four years to 2014-15, such transformational changes are expected to generate 20% of the total savings, but the government expects that by the halfway stage – the end of 2012-13 – just 7% (£875 million) of savings will have been generated in this way.

Commenting on the report, Dr Mark Porter, chair of BMA Council, said: “We share the committee’s concerns about some of the things that are happening as a result of cost pressures on the NHS.  Doctors base their practice on the care of individual patients, and every day see that many of the services deemed to be of low clinical value can be immensely valuable.

“The committee is right to raise concerns about staffing cuts. The Francis report made clear the potential consequences of reducing staff levels under financial pressure.

“We agree that focusing on quality and safety of care, rather than knee-jerk cost-cutting, is the best way forward in the long-term. Clearly the challenge of dealing with financial pressures is huge, and it will be best addressed if clinicians are involved in decision-making. There needs to be wide engagement on how to tackle the decisions facing many parts of the NHS.”

Changing the way services are delivered means in some cases centralising services or providing more community-based care, closer to people’s homes, the report says. This is expected to lead to some hospitals reducing the range of services they provide and departments, and even whole hospitals, closing.

Such change is usually contentious, it concludes, and what might make clinical and financial sense is often not supported by local people. “The government has not yet convinced the public or politicians of the need for major service change or demonstrated that alternative services will be in place.”

Read the PAC report.

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One Response to “Cut NHS demand rather than ration, MPs say”

  1. Malcolm Morrison says:

    Under the present system THIS HAD TYO HAPPEN. So long as one has an INCREASING DEMAND (due to people living longer and there being many effective, but expensive, treatments that improve their quality of life) and LIMITED SUPPLY (due to a restriction of the amount of money put into the NHS by politicians, rather than increase taxes), then “something’s got to give” – i.e. RATIONING – but it will be done by the Commissioners ratyher than the politicians!

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