In Wales, the NHS is set for a real budget cut of nearly 11% over four years, while England escapes the deepest cuts across the four nations, according to John Appleby, Chief Economist at the King's Fund on bmj.com today.
In much of the discussion and debate about health care spending and reform, the "N" in NHS seems often to stand for England, writes Appleby. Yet around 10 million people in the UK do not live in England or use its health care services.
Given the political arguments about whether the NHS budget has received a real increase in funding over the next four years as the government claims, it is important to be clear about which NHS is being protected (or not), he argues.
Certainly planned health spending is not going up in real terms – it will be cut by around 2.2% by 2014/15 in Northern Ireland. And in Scotland, NHS spending will be cut in real terms by around 3.3% this year (with no plans yet made for spending in subsequent years).
Wales faces the deepest cuts of all (nearly 11%). As for the NHS in England, it looks as if real spending will be around 0.9% lower in 2014/15 than in 2010/11. For the UK NHS as a whole, funding will be cut in real terms by 2014/15.
NHS spending in England dominates UK spending of course, says Appleby, with spending in London equivalent to the combined budgets of Scotland and Wales. But he points out that, traditionally, spending per head in England has been lower than in all other parts of the UK.
"On average, over the last seven years, NHS spending per head in Scotland has been around 15% higher than in England – equivalent to a financial gap of over £15 billion; or the annual budget of London's entire NHS," he concludes.