The NHS will be told to rein in its spending next year, potentially forcing cuts in services, managers say.

In 2009-10 trusts will be permitted to use only £400 million of the £1.7 billion surplus that they are expected to generate this year, and will not get the full increase in resources pledged to them by the Treasury, the Health Service Journal reports.

Managers say that spending restrictions will require trusts to scale down service plans, which could mean cutting anything not seen as a local priority. One finance director said this would affect care, as the staff involved organised patient records, operating theatres and appointments. “Even if you slightly get that wrong and don’t make an appointment in time, people die,” he said.

There have been warnings that after 2010 the NHS should expect its funding to grow by between 1.5 and 2 per cent, compared with the 6.7 per cent promised in the Comprehensive Spending Review for the three years to 2011.

There will also be clawbacks on allocations to primary care trusts. Last year the Department of Health saved up to £870 million by increasing allocations by 5.5 per cent rather than passing on the Treasury’s full 6.7 per cent. The department is expected to do the same for next year, saving itself nearly £1 billion. Hospital trusts expect that they will have to reduce non-clinical staff bills by 3 per cent, either through redundacies or freezing posts.

The NHS generated a surplus on its budget of £90 billion last year after three years of deficits. Nigel Edwards, policy director of the NHS Confederation, suggested that the latest restrictions were a repercussion of the recent financial rescue. “We have just put £500 billion in the banks and we can’t pretend that didn’t happen,” he said.

“It’s about how [the NHS] manages it. Any feeling that people have been top-sliced or raided will represent a potential loss of trust. Next time people are told to make a surplus, it will be less easy to persuade clinicians this is a good idea.”

According to a study, standards of healthcare in Britain are worse than in the former Soviet republic of Estonia. Services in Britain were ranked 13th in a league table of European nations compiled by Health Consumer Powerhouse, a Swedish think-tank, which uses criteria such as patient rights and information, waiting times and the range and reach of services.

The Government dismissed the data as flawed, and Mr Edwards said that anything but a broad comparison using the figures was meaningless. Alan Johnson, the Health Secretary, said the index was “not in the same category as the respected Commonwealth Fund report”, which found that Britain had one of the best health services for access, efficiency and treating chronic illness, comparing favourably with those in Canada, New Zealand, France, Germany and the US, the Commonwealth Fund authors said.

In the Swedish think-tank’s index, Britain improved on its position last year when it was four places lower. The best-performing countries were said to be the Netherlands, Denmark, Austria and Luxembourg.

European health league

1 Netherlands
2 Denmark
3 Austria
4 Luxembourg
5 Sweden
6 Germany
7 Switzerland
8 Norway
9 Finland
10 France
11 Estonia
12 Belgium
13 UK
14 Hungary
15 Irish Republic
16= Czech Republic/Italy
18 Spain
19 Greece
20 Slovenia

Source: 2008 Euro Health Consumer Index

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