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Page last updated at 17:04 GMT, Monday, 26 April 2010 18:04 UK

Health: Can the NHS be protected from cuts?

Branwen Jeffreys
By Branwen Jeffreys
Health correspondent, BBC News

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Throughout the election campaign the BBC's expert team of journalists is examining the key claims made by politicians and assessing what their policies and promises mean to you.

Welcome to Reality Check. Today I'm asking whether the NHS can be protected from cuts.

Gordon Brown has pledged to "fight for a better NHS" under Labour, David Cameron says he will "cut the deficit, not the NHS" with the Conservatives, while the Liberal Democrats' Nick Clegg says his party would protect some front-line services in the NHS such as dementia and cancer care.

While no politician wants to be seen to be making cuts to the NHS, the reality is that given the state of UK finances, whoever forms the government after 6 May will be under pressure to reduce the cost of providing healthcare.

The NHS - a devolved issue - is a huge part of public spending. This financial year the budget for England alone is £102bn, a figure reached after record increases. Average spending on the health service has grown at record levels: 6.6% every year in the last decade.

Graph showing NHS spending by government

But there's no suggestion any party will be able to continue that rate of growth.

The Liberal Democrats are making no promises after this financial year. Labour says there will be inflation-only increases for the next two years. The Conservatives promise real-terms increases throughout the next Parliament, but that's unlikely to be more than inflation plus a small amount.

What this means is that the health service is facing a big financial shock - as even a small increase in spending above inflation will not keep pace with the ever-rising costs of healthcare.

Graph showing rising NHS spending

Pressures on the health service are growing all the time, driven by our ageing population, disease linked to our lifestyle - such as obesity - and the rising cost of new technologies and medicines.

The cost of the growing number of older people needing treatment is estimated at between £1bn and £1.4bn a year by independent think tank the King's Fund and the Institute for Fiscal Studies.

The impact of changing lifestyles is harder to quantify but there is a consensus that the burden of disease is growing.

And health economists estimate new treatments and technologies will add between 0.5% and 0.75% to costs - at least £500m a year - to NHS budgets.

Management and administration

If you look at one new medicine being evaluated for the NHS in England you get some idea of the impact this can have.

Dronedarone, a new drug to treat abnormal heart rhythms, costs £2.25 a day. An older medicine called Amiodarone costs just 5p a day.

It's been very roughly estimated that around 190,000 patients in England might benefit from the new drug. However, if they all switched the cost to the NHS would rise from around £3.4m to £156m a year.

So how do the parties propose to deal with these growing costs?


The NHS in England has already been warned it needs to find £15bn to £20bn in efficiency savings by 2014, figures accepted by the three main parties.

Cuts to management and administration costs are a favourite explanation for how this will be managed.

The highest estimate of all management and administration costs in England is from research commissioned by the government from the University of York.

It puts it at around 14% of overall spending - less than the savings the NHS is being told to find.

No-one thinks the health service can run without managers, nor the people who keep the system working by booking your appointments, for example.

So as the cost of front-line services continues to rise, looking for efficiencies elsewhere, although attractive, has its limits.

The reality is that promising to protect front-line services appeals to voters, but fulfilling that promise is likely to prove difficult.

It will mean tough decisions about how costs can be cut - and that may well affect the range of care offered in your local hospital.

A selection of your comments are below.

Why is the NHS any different from any govt. dept? Cuts need to be made, all must help. The social and medical bill for the UK is unsustainable. Maybe a few less managers or a lot less would be a start.
D.Brixey, Devon

My wife works for an NHS trust which is so cash strapped, it has stopped providing childcare vouchers. She also has to pay for any training she wants herself, and even provide her own pens! Where are the savings going to come from here??
Paul, Oxford

NHS is a bottomless pit, the more money ploughed in, goes on wages for higher and middle managers. To ensure good quality service reward nurses at the expenses of pen pushers. You don't need hundreds of modern matrons, just one per Trust is adequate. As a nurse myself half of my time [is spent] in front of the computer filling forms to meet targets.
JSB, Manchester

Why should it be immune from cuts? The fat in that organisation must be colossal
PAC, Preston

One or two managers yes; a plethora of managers no. There are too many checking that the one below has checked that the one below has checked the one below has made sure the...
Chris, Bedford

I work for the NHS, and agree the funding needs to be reduced, but it needs to be reduced in the right way. Reducing the number of clinical staff will have an adverse effect of the quality of care given. Where attention needs to be focussed is in the cutting of bureaucracy, paperwork, red tape, etc. Reducing things like these will first and foremost increase the quality of care given, because clinical staff will have more time to devote to patients and the cost of providing that care will naturally be reduced.
Mark, Birmingham

I work as a mental health nurse in the NHS. I can't think where the cuts can come from. We can't even replace our worn batteries in our mobile phones to get them to work correctly. You have to ask yourself would any of the party leaders or their close family have to wait for health care if they became ill. I don't think you? If you or one of your family members become ill will you just accept that you will have to wait longer for health care to help bail out the banks?
John, Lincoln

Healthcare costs rise at a higher rate than inflation because of innovation - new treatments and new investigations cost more than old ones. Add in the aging population and the fact that more people are living longer with chronic illness and therefore requiring expensive treatment sometimes for many years and you have the makings of a financial black hole. The logical answer is that cuts must be made and treatments rationed but logic tends not to apply when it is we ourselves or our loved ones who are suffering from some terrible illness for which a treatment exists - at a cost. Then we feel that money should be no object!!
Harriet, Newton Abbot

The NHS is seen as a money tree by suppliers. The only way to stop the NHS getting ripped off is to cut the materials and drug budget. It forces the price down. Privatisations and staff reductions are so destructive. We end up with a fragmented, demoralised and useless service.
Mark, Portsmouth

The reality is that we can't afford the NHS we want. It could soak up 100% of GDP and it still wouldn't be enough, as when it's you or you loved one who's ill, there can never be enough healthcare. And all healthcare isn't free. If I need dental treatment, it is means tested, not free. There's no real answer to this as we don't want the politicians to tell us the truth. We all want the best possible healthcare, along with the best education, police, army etc etc. And the politicians promise this. But in reality, as a country we don't earn enough for all this.
D Brown, Manchester

I find it very interesting that those who actually work in a clinical capacity in the NHS are constantly requesting cuts in manager numbers. We must surely take notice of this. Any cuts in clinical staff will obviously harm patient care in some way. My only concern is that it will be managers implementing any cuts and it is very unlikely they will cut there own positions or any of their non-clinical support staff. Their first target will be clinical staff.
Nick, Kent

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