NHS ring-fencing could jeopardise health gains

Ring-fencing the NHS budget could jeopardise public health gains and be a barrier to the integration of health and social care, a healthcare academic has said.

The argument was made by Professor David Hunter, professor of health policy and management at Durham University, during a debate with the King’s Fund’s chief economist John Appleby about whether ring-fencing the NHS budget was fair. 

In the discussion, featured in the BMJ, Professor Hunter said the government should not plough resources into treating patients who lead ‘unhealthy lives’ but instead should focus on prevention.

'If the NHS budget was not ring-fenced we could take public health and health inequalities seriously and ensure that resources are directed to where the pay-off will be highest,' he said.

'Securing integrated care across the health and social care interface is another longstanding battleground, with cost-shunting evident in both directions over many years. This is likely to get worse in future as a result of the public spending cuts and a ring fenced NHS budget.'

But Mr Appleby argued that the alternative to ring fencing would be 'too painful', outlining that if the NHS budget is not protected around £18bn of cuts would have to be made over coming years. He said this could be achieved through staff pay cuts, sacking all GPs and consultants, or abolishing the NHS in Scotland and Wales.

Mr Appleby said: ‘None of these is very appealing, but it underlines just how hard it is going to be for non-protected services… and what spreading the pain would actually entail.’

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