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If there is a funding gap i.e. a gap between what the service needs to deliver and how much it is funded to do so then that means that services will be paid less to do more. i.e. trusts' budgets are being cut by 5% year on year by reductions in tariffs for PbR. Therefore trusts have to make cuts - they may make cuts by cutting staff numbers or skill mix, or restrict provision of certain services, or reductions in the specifications for the service such as numbers of care episodes provided. There have been very real cuts to mental health services for example. So "efficiency savings" do lead to cuts and any pretence otherwise is from someone without actual experience of what is happening in healthcare on the ground.