The NHS was yesterday confirmed as one of only two government departments not to face budget cuts in the spending review – but patients will still feel the pain.
Key promises, such as a one-week wait for cancer diagnosis and free prescriptions for people with long-term illnesses, have been abandoned. The plan for a new £200 million cancer drugs fund is also under threat.
The NHS will have to find up to £20bn of "efficiency savings" to pay for expensive new treatments and an ageing population – many with illnesses such as heart disease and diabetes. Services and treatments will be rationed. Thousands of NHS staff will lose their jobs.
Overall, health spending will rise by 0.1 per cent a year in real terms for the next four years (from £104bn this year to £114bn) – at the lower end of what NHS managers had been expecting. Capital expenditure, for wards and hospitals, will be cut by 17 per cent.
Health service managers will also have to find £1bn from existing budgets to pay for a new social care fund. In practice, the NHS will increasingly have to carry the burden of looking after patients in the community as local government cuts bite.
The Department of Health said it would cut it administrative budgets by 22 per cent by 2014, including reducing the number of health quangos from 18 to 10. Other savings will be found by increasing the use of the 4,000 clinical scientists employed by the NHS so they do more of the diagnostic work now done by doctors. It is hoped that this could save £250 million a year.
More controversial is the threat to cut the £200 million-a-year fund for cancer drugs which was promised by David Cameron and Andrew Lansley, now Health Secretary, before the election. Yesterday's review merely said the fund would be "up to" £200 million a year, but no final decisions have been made.
Andrew Wilson, from the Rarer Cancers Forum, said: "They must honour this promise."