Both NHS England and NHS Improvement (the organisation that used to be called Monitor and oversees providers of NHS services) have calculated that, without radical change, by 20120/20 there will be a gap of almost £30 billion a year between the demand on services and NHS funding. The FYFV calls for
- £22 billion to be found from within the NHS through efficiency savings as a result of ‘wider system improvements’, reduced demand on services, new care models, and ‘new options’ for the NHS workforce.
- ‘Unlocking’ NHS assets (e.g. selling land or buildings ripe for development);
- Increased government funding of the NHS in flat real terms (taking account of population growth), amounting to £8 billion above inflation.
The FYFV claims that £22 billion can be saved by efficiencies of 2 to 3% by 2020. This is highly ambitious compared with the kind of efficiencies achieved by the wider UK economy or other countries’ health care systems. These savings are also sought on top of those already wrung from the NHS over the past five years through the Nicholson Challenge: every ounce of fat has already been trimmed.
The plan suggests that as much as £7.5 billion of the £22 billion can be saved by ‘unlocking assets’ – i.e. selling off NHS hospitals and clinics to property developers. No consideration is given to alternative ways of making savings, such as ending the highly costly business of running the NHS as a competitive market, or by preventing money being wasted on exorbitant PFI debt repayments.