Cutting the NHS budget can’t just be a matter of tinkering with the numbers

Radical surgery will be required if the gap is to be bridged by cutting services

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“Every little helps”, as the supermarket slogan has it. So we should not dismiss Jeremy Hunt’s pledges yesterday to claw back the cost of treating foreigners or stop people charging cosmetic surgery bills to the NHS.

Hospitals spend £500m a year treating foreigners who are not eligible for free care, but they collect only £73m in charges. The NHS also spends an unknown but probably smaller sum providing cosmetic treatments to UK residents that most people would agree are inessential, such as breast enlargements.

Increasing the amount recovered from foreigners – hospitals will receive a 25 per cent premium on the cash collected from this autumn to incentivise them – and reducing spending on “unnecessary” cosmetic treatments make fiscal sense, even if they have unpredictable consequences on sometimes needy patients.

But will these changes solve the NHS cash crisis? Of course not. If the twin measures saved £300m per annum between them it would be impressive – but would still amount to less than 1 per cent of the £30bn savings required by 2015. Much more radical surgery will be required if the gap is to be bridged by cutting services. Medical organisations such as the BMA have repeatedly tried to define “core” NHS services which should continue to be provided free, while charging for the non-essential remainder – procedures such as IVF, varicose veins, and cosmetic surgery, plus treatments for foreigners.

Drawing the boundaries is tricky. Enlarging breasts or improving the shape of someone’s lips are things we might regard as non-essential. But surgery to remove an unsightly birthmark from a child? The idea of devising a list of core services has  been tried in the US state of Oregon, and in New Zealand, but it got almost nowhere. Once agreement had been reached, the basket of treatments in the non-essential category had shrunk to insignificance. Mr Hunt or his successor is going to have to take some much more radical measures to meet the shortfall.