In evidence to the House of Commons health select committee on Tuesday, NHS chief executive Sir David Nicholson said the DoH was ‘very alert’ and took action to prevent cuts that damage care.
But he admitted: ‘Even if we safeguard against it, sometimes it will happen. There is no benefit to the system to do that. We want people to make proper efficiency gains.’
He said the DoH had sought to ‘build in assurance’ by implementing a system in which senior clinicians sign off trusts’ ‘cost-releasing programmes’.
Sir David told MPs that the DoH had had doubts over whether the quality, improvement, productivity and prevention (QIPP) savings target of £20 billion was achievable under the NHS structure in place under the Labour government.
Cuts to management staff and clustering of PCTs had delivered administrative savings of £240 million in 2010/11, health secretary Andrew Lansley told the committee.
He added that spending on management consultants had been cut by 50%.
DoH permanent secretary Una O’Brien confirmed: ‘The expenditure on management consultants has come down dramatically since the election.’
But Rosie Cooper (Lab, West Lancashire) told Mr Lansley: ‘The reality out there is not quite the pretty picture you are painting.’ NHS organisations did not cut frontline services unless they had no other option, she said.
Ms Cooper added: ‘You have to be demented if you think people and the health service are behind you.’
Mr Lansley admitted that the NHS faced ‘considerable financial pressures’. Mr Nicholson admitted that things were ‘not all fine’ and that the financial challenge for the NHS was unprecedented. But he rejected a claim from Ms Cooper that patients were ‘paying the price’ for cuts.
Mr Lansley added: ‘We do live within a budget, but this is an unprecedented focus on how we can deliver quality through the clinical redesign of services. We have to deliver the best possible quality within that budget.’
He said that in the past, quality had suffered when PCTs commissioned services on cost and volume.
Mr Lansley identified ‘particular opportunities’ in urgent care. ‘It will be achieved by integrating GP out-of-hours services with things like walk-in centres and NHS Direct and some of the aspects of the ambulance response in a way that is safe and it need not be in a way that is anything other than cost effective as well.’