Health chiefs facing budget cuts look to spare frontline services

The management board of NHS Sheffield is due to meet today, and members will examine a 128-page report which outlines how it expects to operate over the next four years.

NHS Sheffield is responsible for providing all so-called "primary" healthcare services across the city, including GP practices, dental surgeries, opticians, pharmacies and mental health.

It was formed in 2006 after the merger of four separate primary care trusts, has an annual budget of around 1bn and also commissions services from the city's hospital trusts.

The document which will be examined today presents the "financial context" that managers expect to face until 2014, and sets out three scenarios which could affect health spending.

In the worst case, managers expect that annual funding could fall by around 16m a year, leaving them with tough choices to make about which parts of their operation to scale back.

NHS Sheffield first published its Achieving Balanced Health plan in 2007 and according to the report, since then it has been able to repay a large amount of debt and invest in new initiatives.

But it is now expected that annual funding increase to the trust will drop significantly, leading to the creation of the three scenarios which aim to ensure that essential services are not cut.

The report, which has been jointly written by NHS Sheffield's chief executive Jan Sobieraj and chairman Tony Pedder says: "The overall national context has been one of sustained additional funding for the NHS.

"This has allowed significant improvements in terms of access to services, including waiting times, quality of services use of new technologies and treatments and in new facilities.

"In parallel, patient expectations and experiences have risen and improved.

"This has been the case locally as demonstrated by recent positive external performance assessments.

"The challenge going forward is to continue to improve quality and meet patient and public expectations in what is likely to be a sustained period of limited additional resources."

Finance staff at NHS Sheffield have been asked to model their three scenarios on a "base case" an "optimistic case" and a "pessimistic case" to ensure that decision on how to spend can be made in advance.

The report makes it clear that managers expect to be faced with a drop in Government funding, and outlines how

cuts to services with "less impact" on people's health could be cut.

They include possible reductions in spending on interpreter services, a reduction in investment in psychological therapies and a cut in the amount spent on improving learning disability services.

Statistics prepared by NHS Sheffield for today's board meeting show the scale of the reduction in funds expected, with annual increases from the Government expected to be as low as one per cent.

In recent years, the annual increase on the budget available for health services in the city has been as high as 8.5 per cent.

The report says: "Essentially, the assumptions reflect that in the light of the overall UK economic challenges, funding for public services is expected to be under close scrutiny.

"The NHS is not expected to benefit from the significant levels of growth in funding experienced in recent years.

"Instead, we will need to demonstrate significant improvements in quality and productivity within a 'resource-constrained' environment."