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It’s about time we called a cut a cut

PCTs across the country are scrapping frontline services at an alarming rate in an attempt to meet the £15bn 'efficiency savings' asked of them – despite Whitehall's promises this wouldn't happen. How about a bit of honesty from the next government?

Liberal Democrat leader Nick Clegg won plaudits during last week's television debate when he called for politicians of all parties to be upfront with the British people about the economic crisis. They could do worse than to start with the NHS, and in particular by banishing the term ‘efficiency savings' from their lexicon. As Pulse's survey of GPs this week makes only too clear, these words are barely concealed code for cuts.

It's not that there aren't plenty of efficiencies to be made. Successive Pulse investigations last year found spending by PCTs on external consultants had increased threefold, and on manager salaries by 25%, over just two years. But trusts are being asked to take £15-20bn out of the NHS budget in the next three financial years.

If they stopped using external consultants immediately, as they surely must, that would save around £180m a year – a huge amount, but still a fraction of what is expected of them. Cutting the number of managers by around a quarter, as is planned, will bring big savings, but also big redundancy payouts. Sadly, waste begets waste. It is disingenuous to suggest money can be taken out of the health service in the quantity and pace required without cutbacks to the front line.

Our survey reveals just what impact those cuts are already having. Patients are being asked to travel further for access to phlebotomy, the number of district nurses is being reduced, maternity services are being closed. Alarmingly, GPs say access to palliative care is suffering, and that perennial Cinderella, mental health care,

is once again being denied its place at the ball. PCTs have perhaps been left awash with cash for too long, because it appears the moment their funds have tightened, they have descended into a collective, trigger-happy panic. It is scarcely believable that at such a time of financial crisis, our politicians are competing with pledges for seven-day-a-week access to GPs and the offer of a second wave of wasteful Darzi centres.

Whoever wins the next general election must be honest enough to admit that if money has to be taken out of the NHS budget, there will need to be some tough choices about what the health service can or cannot provide. But our politicians must also have the guts to withstand the pressure for instant efficiencies and an immediate impression on the bottom line. They must, as the Conservatives have promised, give PCTs time to consult fully and openly with GPs about how services can be provided more efficiently, and which can no longer be provided at all. Tory leader David Cameron argues our public services must be able to deliver more for less. They must, but sometimes they need to be prepared to deliver less for less, too.

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