NHS Cambs looks budget cuts in the eye

WHEN the effects of recession really start to bite on the National Health Service in two years time, it will be faced with delivering the same level of healthcare to a greater number of people with 15-20 per cent less cash. Senior managers and healthcare

WHEN the effects of recession really start to bite on the National Health Service in two years' time, it will be faced with delivering the same level of healthcare to a greater number of people with 15-20 per cent less cash.

Senior managers and healthcare professionals last week started planning for how that can be achieved when NHS Cambridgeshire's �750million-a-year budget is reduced to as little as �700million in real terms.

With demand for healthcare increasing in volume terms as year succeeds year - if only because people are living longer, but also because of new treatments becoming available - and with the fastest-growing population in Britain, radical solutions will be required if patients are not to suffer.

But patients, too, must stop wasting NHS resources by demanding treatment for which they have no medical need - partly the "worried well" syndrome but also some patients who regard the NHS as an extension of their social activities or a passport to benefits.

Cambridgeshire is believed to be the first area of the country to have started to grasp the nettle of a likely sharp reduction in the money available for healthcare, which is ring-fenced by real-terms increases in England of 7.5 per cent in the current year and 1.6 per cent next year.

But the party is over in April 2011, by which time virtually every other Government spending department will already have faced swingeing cuts.

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At the heart of the problem is the banking sector, which is widely acknowledged to be at the root of the economic crisis - not just because it fuelled overheating housing markets internationally, but because of wider irresponsible lending to people who could not pay back the money.

To prevent total collapse of the banking system and prevent disintegration of national economies, the UK and other governments around the developed world have thrown huge sums into the ring to keep industries afloat and to support the growing number of folk who have lost their jobs and their families' financial base.

The Treasury's total debt is likely to have risen to around �180billion by this time next year - far too high in relation to GDP - and most of it must be paid back as soon as possible to stabilise the economy. That means tax increases and savage spending cuts.

Because it already accounts for �1 in every �5 of our money that the Government spends, the NHS can no longer be immune. Protecting healthcare from economic reality is now seen by economists and academics as no longer an option, whoever wins next year's General Election.

Ironically, the meeting at which those experts met senior NHS managers from Cambridgeshire to start the process of dealing with the crisis was held outside the county - at Wyboston in Bedfordshire - but probably because the organisers had not noticed where the county boundary lay.

Cambridgeshire is already at the niggardly end of NHS spending - we get around �1,250 a year per person, compared with �2,100 in inner cities, where need is greater but meeting that need is simpler. And, because health spending follows population growth, often by several years, per capita spending in Cambridgeshire will fall sharply while it increases steadily in inner cities as the population declines.

The other problem the NHS has is that it has historically not been very good at productivity. In net terms, the economists said, there has been none.

Yet it is productivity and a reduction in the volume of activity that are at the heart of the rescue plan for Huntingdon's Hinchingbrooke Hospital. To ensure its survival, the number of cases treated there was supposed to have reduced by 20-25 per cent. Instead, that number has risen, largely because GPs believe Hinchingbrooke is where their patients will get the best treatment.

The demand for treatment rises naturally in recession, when unemployment or fear of unemployment increase people's susceptibility to first mental, then physical illness.

What must happen, the experts agreed last week, was that patient dependency on the NHS must be severed, so that healthcare was delivered only to those who needed it. In part, changing lifestyles - less smoking and drinking, better diet and more exercise, which have been shown to improve both physical and mental health - would reduce the call on the NHS and its budget.

Yet, because people who follow healthier lifestyles live on average 14 years longer, there is a greater burden in treating the elderly.

What also seems clear is that NHS employees will have to share the pain. They have been immune from pay cuts and freezes in the wider economy so far, but that cannot continue. Yet it will be difficult to reduce nurses' pay at a time when wages are starting to rise again in a wider, recovering economy.

Squaring this circle is not going to be easy, but the process has started.