Helen Salisbury: Austerity and efficiency in the NHS

If you eat less you get thinner and have to tighten your belt. Of course, this isn’t always good for you—it depends on what your waist measurement was to begin with. A new round of belt tightening for the NHS has just been announced by the government, but as the UK lags behind its European neighbours in terms of per capita health spending, it arguably doesn’t have much fat to trim.12 The stated aim of the latest austerity measures (euphemistically referred to as a “financial reset”) is to “cut bureaucracy and invest even further in the frontline.”3 These cuts are unlikely to make the NHS leaner and more efficient, and patients will inevitably be harmed.

Some trusts are being asked to cut their spending by as much as 12%. When estimates of spending on management are in the region of 2-3% of the overall NHS budget it’s clear that these cuts will come at the expense of patient care.4 Nor can we afford to reduce the amount of management in the NHS, as the service is already undermanaged.5 Doctors and nurses alone can’t make the changes that would improve efficiency.

Clearly there’s room for improvement. Many patients are well aware of—and frustrated by—the poor organisation and communication that results in multiple letters being sent about the same clinic, often arriving after the appointment date has passed. However, what drives such inefficiencies tends to be staff shortages and underinvestment. Last week GPs in a neighbouring county to ours were spending 40 minutes on the phone trying to get through to their local hospital to refer patients, and many had to resort to simply sending them to the emergency department. Do switchboard operators count as frontline staff? They’re certainly essential to the smooth running of a service.

A more efficient NHS would provide a better service for the same cost. Many people have made suggestions about how we could achieve this, but most of these require initial investment in people and technology. Some of the changes needed to improve the interface between GPs and hospitals, such as hospital electronic prescribing6 and efficient systems for seeking advice,7 would be relatively easy to implement but are unlikely to happen if spending is frozen.

These belt tightening measures, along with the dismantling of NHS England and the 50% cut in integrated care board budgets, are being done in the name of efficiency. But we should learn lessons from across the Atlantic, where swingeing, ideologically driven cuts to spending are damaging all parts of the US public sector, with no obvious increase in value for money.8 Just cutting a budget without a well thought-out plan doesn’t magically improve efficiency, and it’s very likely to disrupt the healthcare you were trying to deliver.9