JOHN Glen writes that “the government has not been underfunding the NHS”. Given his role in the Treasury his response was not unexpected. Yes there has been some investment although some of this quickly disappears through government decisions such as increases to NI and pension contributions and NHS contributions to social care due to cuts in council funding.

The figures for the UK are very large and members of the public have great difficulty in knowing if the NHS is actually underfunded or not.

Some facts about the current state of the NHS:

  • There are very serious national clinical staff shortages due to a disastrous failure to invest anything like enough in training over the past ten years, and care is undoubtedly affected
  • Waiting lists are growing significantly
  • Demand has grown well beyond expectations due to a growing and ageing population
  • Capacity is inadequate to deal with this growth due to repeated national cuts. The UK has a relatively low number of beds compared with similar Western nations
  • Emergency departments frequently are congested causing some patients to be treated in corridors or ambulances
  • Primary care, community services, mental health services and social care are all struggling to cope due to funding and staffing
  • Most acute hospitals are in deficit or being bailed out financially due to nine years of unrealistic government efficiency targets. This year care providers in England are expected to save £3.7billion, which is very unlikely.
  • Many elderly patients are in hospital unnecessarily through lack of care in the community due to cuts in council funding.

So, if the NHS is adequately funded, as suggested, then it must be incredibly inefficient. But international comparisons indicate this is not so. The Lord Carter national review of NHS procurement and efficiency identified relatively low levels of potential savings.

Clearly there are always efficiencies to be made and the Treasury seizes on specific examples to justify not providing more funding. Savings could be made by cutting bureaucratic regulation and scrutiny on the NHS and consolidating the expensive commissioning of care. But the scale of potential savings is now far too low. Indications are that underfunding will reach £20billion by 2022 if current trends continue.

The public needs to decide whether to accept the view of the Treasury or that of NHS workers regarding current funding levels.

The independent ‘Kings Fund’ ( is very helpful in understanding the truth.

Given the parlous state of public funds, an independent ‘Royal Commission’ must review NHS planning, funding and staffing in order to get a proper perspective on what is realistic and what the NHS can no longer afford to do – something the government has so far resisted.

Malcolm Cassells, Former finance director at Salisbury District Hospital