Care services 'tested to limit' by £20bn cuts

A report by the Health Select Committee says no health system anywhere in the world has ever achieved the 20bn scale of savings required by the NHS over the next four years.

In a blow for the Government, the committee, which has a majority of coalition members, expresses doubts over a key Government pledge that the NHS will get real-term increases in spending.

They say it is vital savings are made through efficiency gains rather than cuts but criticise the Government for failing to provide detail on how this will be achieved, describing an "urgent need for a credible plan".

They raise further concerns that savings will be required at the same time as a major restructuring in the NHS is carried out.

MPs also say they fear sweeping cuts to social services budgets held by councils could put further pressure on the NHS, rejecting assurances from Ministers that access to social care will not be hit.

Committee chairman Stephen Dorrell, a former Tory Health Secretary, said: "The government's plans for health and social care are based on assumptions which will test these services to the limit.

"There is no precedent for efficiency gain on this scale in the history of the NHS, nor has any precedent yet been found of any healthcare system anywhere in the world doing anything similar."

Ministers say as much as 40 per cent of the savings required by the NHS will be achieved by reducing the amount hospitals are paid for carrying out standard procedures.

But the committee said it was "sceptical" about the claims, raising concerns that it would lead to reductions in the quality of care and "crude cost shunting", effectively putting the burden on hospitals to achieve savings.

The committee said it was "unfortunate" Ministers had not even provided an estimate of the costs of the forthcoming NHS reorganisation that will hand responsibility for buying services to GPs.

Mr Dorrell said it was widely accepted that when failures occurred in social services that the burden fell on the NHS through higher hospital admissions, delayed discharges and worse outcomes for patients.

His committee's report welcomed plans to transfer 1bn from the NHS to councils to develop social care facilities but warned better links between health and social care were "mission critical" to the successful delivery of savings across the board.

The report comes amid growing concerns about pressures on NHS budgets.

British Medical Association (BMA) chairman Hamish Meldrum, a GP in Bridlington, said doctors were already seeing "widespread cuts to staffing and services".

"There is evidence of posts being frozen and services rationed," he said.

"We urge the Government to give greater clarity and to explain to healthcare staff, professional bodies and patients, the true scale of the savings required and to ensure the service has a proper strategy as to how it is going to find them.

"The BMA is particularly concerned about cuts to the adult social care budget and we fear vulnerable people may suffer. With an ageing population, it is likely that the number of older people who need help and assistance will increase," said Dr Meldrum.

A Department of Health spokeswoman said: "The Government is committed to the NHS – to sustain and to improve services in the face of a tough economic climate.

"But even with this commitment, in order to meet demand and improve the quality of services, the NHS needs to make up to 20bn of efficiency savings by 2015.

"Reform isn't an option, it's a necessity in order to sustain and improve our NHS. We have been clear that the NHS must cut back on bureaucracy, not on frontline care."

The department insisted day-to-day funding for the NHS would grow in real terms for the next three years and claimed additional investment in social care would protect access without reducing eligibility.

Managers bank on new methods

Health services in Yorkshire must make 1.6bn savings between 2011 and 2014.

NHS bosses say this will be done by reducing waste and increasing productivity but without compromising patient care. They claim frontline services will be protected but organised and run differently, in some cases with fewer staff.

More services will be provided in people's homes or in the local community rather than in hospital, with greater access to telemedicine, allowing people to stay at home.

Patients will spend less time in hospital and measures will be taken to reduce demand for emergency care.

Access to planned surgery for some conditions could also be limited.