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Reaction: The Comprehensive Spending Review and the NHS

Key healthcare opinion formers give their reaction to the Department of Health's settlement in the Government's Comprehensive Spending Review.

To read Pulse's story covering the spending review and the implications for the NHS, please click here.

Dr Hamish Meldrum, BMA chair

'The BMA is pleased that the government has kept its pledge to protect health spending, in real terms, over the course of this parliament. We also welcome the news that spending on NHS research will grow over the course of the spending review.'

'Although the NHS budget has been relatively protected, the health service has to find cost savings of £20 billion by 2014 and this is already resulting in cuts to services, staff and rationing of treatments. The NHS continues to face the demands of an ageing population and the rising costs of medicines and new technology.'

'Cuts in spending in other areas, such as welfare benefits, will also have a knock-on effect on demands on the NHS. Vulnerable groups often have complex health needs and it is essential that help remains available to them.'

'The Chancellor's remarks about productivity are worrying. Doctors and nurses work extremely hard to care for their patients and will continue to do so despite the challenging times ahead. In the last decade the ‘productivity' of healthcare staff has contributed to reduced waiting times and improvements in the quality of patient care. If the government is truly committed to reducing waste and inefficiency, their proposals for NHS reform should focus less on competition and more on a cooperative approach on delivering healthcare.'

Nigel Edwards, acting chief executive at the NHS Confederation

'Given the huge financial pressure on our public services, this settlement is as good as the NHS could have hoped for under the circumstances, although £1 billion a year will be routed to social care.'

'The high level of unavoidable pressure on NHS finances – from increasing demand to new technology and structural reform – means the government is right to treat healthcare differently. Even with this settlement, the NHS faces a potent cocktail of pressures and we will have to work very hard to ensure the impact on services is minimised.'

'Even with this settlement, the NHS is going to have to really up its game on productivity because of high levels of increasing demand and new technology. We already have some of the most stretching productivity targets anywhere. Achieving more will be immensely difficult when we are going through such a major programme of structural reform.'

John Appleby, chief economist at the King's Fund

‘Compared to other departmental budgets the NHS settlement is a generous one. But, while the increase in health spending meets the pledge to protect the NHS budget, an increase of 0.1% in real terms will soon be swallowed up by cost pressures such as incremental pay drift and the increase in VAT. The net result will be a reduction in the NHS's purchasing power.'

‘This places even greater emphasis on finding the £20 billion in productivity gains targeted by the NHS's chief executive - the status of this has moved from an ambition to a commitment. Our work has highlighted opportunities to improve efficiency at every level of the health system. Delivering on this represents the biggest financial challenge the NHS has ever faced but it is imperative if it is to maintain quality and avoid cutting services.'

Dr Jennifer Dixon, Nuffield Trust director

‘The NHS is in a privileged position compared with other public services and the Government should be credited for protecting health spending.'

‘But make no mistake – the NHS has not faced this level of challenge in its history. The real terms increase in total health spending will be just 0.4 per cent over the spending review period – 2011/12 to 2014/5 – i.e. 0.1 per cent per year. In reality, unless the NHS can keep a tight grip on pay and price inflation, this will mean a reduction each year in the volume of health care services the NHS can deliver if current trends continue.'

‘At the same time, the NHS will have to deal with three major pressures. First, those arising from increasing demands from a rising and ageing population – just standing still and delivering the same services is forecast to cost the NHS just over £1bn extra a year.'

‘Second, the significant reforms the NHS must deliver, set out in the recent white paper. Third, we welcome the extra £2bn per year announced for social care, although we will need to examine the detail of this announcement. £1bn of this will come from the NHS capital budget from 2011/12 to 2014/5 and an additional £1bn per year added to the Personal Social Services grant to local government.'

‘But the reality is that local authority budgets will be stretched and funds for social care are not ring-fenced, so the extra £1bn per year is by no means certain. Research to be published by the Nuffield Trust next month reveals how social care can substitute for hospital care and vice versa by helping to reduce admissions or earlier discharge from hospital. It is vital that social care is adequately funded otherwise there will be even greater pressure on health budgets.'

‘The biggest question now is whether the NHS can meet the £15bn-£20bn of efficiency savings now needed at the same time as significant reorganisation and cuts in management costs of 45 per cent. Productivity increases of around 4 per cent or 5 per cent a year are now required. This is unlikely to happen without fundamental changes to services in some parts of the country.'

Karen Reay, National Officer for Health at Unite

'There are two easy alternative strategies to ring fence the NHS – firstly, stop the expensive reorganisation and privatisation heralded in the white paper. And, secondly, look at different ways of cutting the deficit by investing in the economy to create jobs; and cracking down hard on the tax loopholes that allow rich organisations and individuals to run rings around the tax authorities.'

‘It should also be noted that demographic changes, technological advances, and the impact of the Government's deeply regressive budget in June on people's living standards will all put the NHS under even greater strain.'

‘The NHS has been charged with finding £20 billion ‘efficiency savings' from now until 2014/15.'

‘The re-organisation that will result from the privatisation of the NHS in England is going to cost £3bn.'

‘Health secretary Andrew Lansley should stop peddling the myth that the NHS is ring fenced from the cuts – it is not. The CSR has driven a coach and horses through that conjuror's illusion.'

‘George Osborne has said that the job cuts will come through ‘natural wastage' – but our NHS members are already receiving ‘at risk' letters and at a local level, we are already seeing job losses and the deletion of staff posts. The coalition is playing hard, fast and loose with the truth.'

Ian Wootton, partner at PricewaterhouseCoopers

'Increasingly, the NHS will become a system that works to prevent people becoming ill rather than treating them when they are sick. Services will increasingly be centred and provided around individuals as "customers". Achieving this will require a new age of collaboration with the private sector and the introduction of competition, both of which will transform the organisation.'

'The financial reality is that the NHS will have to manage costs and find efficiency savings of 15-20% against slowing revenues over the next four years. There is consensus across government that the integration of health care and social care will make this possible.'

Dr Richard Barker, director general of the Association of the British Pharmaceutical Industry

'The ABPI welcomes the continued commitment from the coalition Government to increase funding to the NHS for every year of this Parliament and increased spending on health research from the Department of Health.'

'The Government's commitment to the Cancer Drugs Fund will mean that more cancer patients will be able to get access to the latest available medicines than before. The UK currently ranks amongst the lowest in Europe in the uptake of innovative medicines, despite having amongst the lowest prices. As the NHS faces the challenge of achieving £20bn annual efficiency savings, innovative new medicines will be an important part of the solution to reduce the long term burden of disease, and so deliver cost-effective care.'

Dr Hamish Meldrum

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