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13-12-2012 | General practice | Article

NHS savings ‘not sustainable’


National Audit Office – Progress in making NHS efficiency savings

medwireNews: NHS management needs to step up its work on reconfiguring services, if it is to deliver further efficiency savings without harming the health service, a National Audit Office report suggests.

Having analysed Department of Health figures for 2011-2012, the NAO says that although substantial savings have been made, the "easiest" have been made first, mainly through public sector pay freezes and cutting back-office costs, and reductions in the price of services to PCTs.

Indeed, 88% of PCT savings were cash-releasing and most of these were made through "contractual levers", including the 1.5% reduction in healthcare tariffs.

The NAO questions whether some of the observed slowing of growth in hospital activity was through improved demand management or inappropriate restrictions on access to services. Indeed, the report highlights that 56% of PCT clusters introduced or raised eligibility criteria thresholds for elective procedures. There have been widespread reports of patients who smoke or are obese being barred from accessing certain services, and of cataract surgery being denied until patients' eyesight has deteriorated to a greater degree.

"This essentially defers rather than avoids spending," the report states. Some clusters even introduced restrictions mainly on financial grounds, while 22% had placed budget caps on GP referrals or set minimum waiting times.

Furthermore, the NAO also questions whether all of the Department of Health's reported £5.8 billion savings were actually delivered.

King's Fund economist John Appleby echoed the report's concerns.

He commented: "In striving to meet the financial challenge, it is vital to retain the focus on improving the quality of care - this is what the QIPP programme aims to achieve. One important but so far under-exploited way of achieving this is to reduce unwarranted variations in performance and treatments."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price, Senior medwireNews Reporter