Changes in the economic mix will result in less room for manoeuvre in the NHS, according to KPMG global head of health Mark Britnell.

Writing in this week’s HSJ, Mr Britnell said the word efficiency is being wrongly interchanged with “cut”.

He said that to make the required efficiency gains, all NHS employers should make pay rises dependent on productivity rises in line with the private sector. The government should also establish public/private joint ventures on an industrial scale, go to market with local government and set up a commercial NHS bank.