Health Service Journal
Noel Plumridge

Noel Plumridge is an independent consultant and former NHS finance director.

Still no change in NHS finance after Francis

17-Apr-2013
The post-Francis world is still worringly ‘business as usual’
Should we worry about the health of NHS staff?

2-Apr-2013
Noel Plumridge’s third dispatch from the stroke ward
Concerns about night time care

26-Mar-2013
Noel Plumridge on what happens on the stroke ward at night
We have been misled over NHS funding

19-Mar-2013
Large amounts of money will never leave the Treasury
Reflections on care on the stroke ward

18-Mar-2013
Noel Plumridge reports on a long-stay patient
Co-payments undermine the NHS's claim to be 'free'

14-Feb-2013
NHS care is not “free at the point of delivery” for patients’ relatives
The profitable prize behind pension reform

9-Jan-2013
Radical changes to pensions enable the government’s goal for the NHS
Liaison psychiatry can bridge the gap

5-Dec-2012
A joint approach to managing physical and mental care is a prime example of integration
Croydon's finance crisis is not incredible

8 November 2012
The £22m black hole is less mysterious given prevailing cultures
There is a Plan B after all

11 October 2012
Public sector employment could be part of the solution to our economic woes, argues Noel Plumridge
Noel Plumridge: the outsourcers' next big prize

27-Sep-2012
The GP community was always divided about Andrew Lansley’s legislation
Noel Plumridge: welcome to unpopularity

13-Sep-2012
This is the world of James Reilly, former GP and now Ireland’s health minister
Putting the quality back into QIPP

6 September 2012
Pursuing value could be the right step towards transforming the NHS
The long term care conundrum

23 August 2012
Demand continues to rise so where does the accountability lie, asks Noel Plumridge
Noel Plumridge: the business of mental health

2-Aug-2012
Delays to the planned mental health tariff will not surprise anyone in the field
Noel Plumridge: when risk assessment goes awry

19-Jul-2012
How necessary monitoring is to avoid failure.
Noel Plumridge: twice the harm

4-Jul-2012
Last week’s announcement that an administrator is to be appointed at South London Healthcare Trust, with all that follows under the National Health Service Act 2006, brings two immediate harmful effects. It’s sad indeed that both appear to have been encouraged and even praised.
Noel Plumridge: the error of underspending

21-Jun-2012
Doubts are being cast on whether austerity is automatically good.
Noel Plumridge: levelling the provider playing field

31-May-2012
HSJ’s financial columnist on ‘sharks’, ‘ugly sisters’ and social enterprise.
Primary care premises may prove too costly for independents

31-May-2012
Will we see GPs on the streets?
Noel Plumridge: in the savings equation, the answer is always QIPP

17-May-2012
Where will 2011-12 savings end up?
Noel Plumridge: the reinvestment riddle

3-May-2012
Where is the process for reinvesting the Nicholson efficiency savings?
Noel Plumridge: CCGs meet their controllers

18-Apr-2012
The commissioning purse strings remain tightly tied.
Noel Plumridge: the hidden cost of foundation status

29-Mar-2012
“Working capital arrangement” can be a £20m trap.
Could an NHS trust be allowed to go bankrupt?

15-Mar-2012
Hospitals in the wrong place at the wrong time are in danger.
Noel Plumridge: do not underestimate CCG support organisations

15-Mar-2012
Could we see CSSs regulate CCGs?
Noel Plumridge: forget hospitals, competition will thrive in non-acute services

1-Mar-2012
“There are rich commercial pickings in non-acute care.”
Noel Plumridge: an uncertain future for payment by results

16-Feb-2012
Where is the detail on tariff for 2013 and beyond?
Noel Plumridge: tariff reductions aren't the one-size-fits-all solution

2-Feb-2012
Timely as they are, the Commons health committee’s warnings about the NHS’s approach to saving £20bn are nothing new.
Noel Plumridge: bonus capital fund threatens to embarrass the system

19 January 2012
The letter sent by the Department of Health in late December inviting bids for a £300m capital fund, favouring projects with greater spend in 2011-12, smacks of someone realising the potential for serious embarrassment.
Noel Plumridge: has the sparkle gone from social enterprise?

12-Jan-2012
Social enterprises are starting to find that the odds are not in their favour in a cut-throat market, which could make for a bleak picture in a decade’s time, says Noel Plumridge.
Noel Plumridge: is local pay a fair deal everywhere?

5 January 2012
George Osborne’s stated purpose in opening up the issue of local pay rates is to ensure “public sector pay does not distort local labour markets”.
Noel Plumridge: this holiday's must-have NHS reads

8 December 2011
For the fast approaching season of peace and goodwill, it’s customary for columnists to offer their reading recommendations for the holiday period.
HSJ supplement - special finance report

2-Dec-2011
This HSJ special finance report looks at the financial future for trusts eyeing foundation status, new legislation designed to stop bribery that could catch some organisations out, and why it can be difficult to find a finance director.
Noel Plumridge: increased demand is the answer, not the question

24 November 2011
In 2009 the UK spent 9.8 per cent of its GDP on healthcare. The equivalent figure for 2008 was 8.8 per cent. Such a year on year increase shows theimpact of continuing investment in the NHS even as the recession took hold.
'A new procurement model could fall foul of inertia'

10 November 2011
Despite talk of opening up NHS procurement, the same old system looks unlikely to be phased out just yet, writes Noel Plumridge.
Noel Plumridge: PbR is becoming increasingly irrelevant

10 November 2011
The strategic direction of tariff funding used to be steady expansion of scope and steady growth in sophistication. In time, it was understood, payment by results would cover virtually the entire English NHS.
Noel Plumridge: new faces for financial frugality

27 October 2011
There are essentially three approaches to the branch of corporate governance that is concerned with ensuring compliance.
Noel Plumridge: savings are not surpluses

13 October 2011
Before we called it “the recession”, it was known as “the credit crunch”. Trading confidence drained away, the banks stopped lending, and anyone with cash held on to it.
Noel Plumridge: checking up on the Nicholson challenge

29 September 2011
Pressed on where the £20bn productivity gain that is now known as the “Nicholson challenge” will actually be found, the top of theDepartment of Health cites a ratio of 40:20:40.
Noel Plumridge: will the government help write trusts' shopping lists?

15-Sep-2011
Two recent public accounts committee reports suggest the NHS may still have a thing or two to learn about shopping.
Debate: is general practice pulling its weight in the efficiency challenge?

9-Sep-2011
On 30 June, HSJ columnist Noel Plumridge suggested primary care should carry its share of the £20bn Nicholson challenge, alluding to the Nuffield Trust’s March recommendation that primary care “should become a key focus of the quality, innovation, productivity and prevention agenda”. Noel’s article led to this correspondence with Pat Stevenson, a GP practice manager in the North East.
Noel Plumridge: inflation is set to inflame the pension problem

1-Sep-2011
The most important economic indicator this autumn is an old friend, reappearing like a toothache you’d forgotten about. It’s inflation.
Noel Plumridge: changes to charitable funding risks donators' benevolence

18 August 2011
If, when the time comes, you leave a share of your worldly wealth to your local NHS, that’s entirely up to you. After all, it’s your money.
Noel Plumridge: the price of reputation

28 July 2011
How would you feel about a health insurer that took your premium payments and then turned down your claim, not on the basis of an alleged pre-existing condition, or something in the contractual small print, but simply because it considered your illness a low priority?
Noel Plumridge: the finance director's job interview

14 July 2011
“May I recap,” she said. “If I’m appointed finance director of the trust, my main deliverable is a financial strategy for foundation trust status within two years?”
Noel Plumridge: time for primary care to shoulder its share of the savings burden

30 June 2011
Around 20 per cent of the entire NHS budget is currently spent on primary care.
Noel Plumridge: breaking up is hard to do

16-Jun-2011
Hanging on to the title deeds of the community estate must have seemed such a neat idea last year, as primary care trusts pondered the future of their soon to be departing provider arms.
Noel Plumridge: parallel process in danger of doubling costs

2 June 2011
First, in April, came the “pause” in the passage of the Health Bill. Then the “listening exercise” and the appointment of the NHS Future Forum. And, along the way, the Liberal Democrats’ humiliation in the May elections.
Noel Plumridge: Monitor is showing a truer picture

19 May 2011
“Breathtaking insensitivity” is the alleged failing of David Bennett, Monitor’s new chair, for daring to suggest the 4 per cent target efficiency gain required of the NHS this year, under the Department of Health operating framework, may be just a little understated.
Noel Plumridge: calling any qualified commissioners

5 May 2011
Last week’s public accounts committee report on the NHS landscape states: “Most important, the department has not yet got a framework to deal with failure in the system, be it on the provider side or the commissioning side”.
Noel Plumridge: PFI pipe dream turns sour

20-Apr-2011
Within the EU, the talk is now of a periphery and a core. Peripheral countries that the international bond market no longer loves – Greece, Ireland and now Portugal – have to borrow large sums of money from the core merely to stay afloat.
Noel Plumridge: RIP, payment by results

7 April 2011
After nearly a decade, it’s time to say goodbye to payment by results.
Noel Plumridge: shouldn't specialist services be cheaper, not dearer?

24 March 2011
The value of specialist top-ups under the NHS tariff is falling. Specialist children’s hospitals had 78 per cent additional funding compared with the standard tariff, but from April their uplift will only be 60 per cent.
Noel Plumridge: what will the year end yield for trust finances?

17 March 2011
Ever wondered why financial years begin in April? It’s the crop cycle.
Noel Plumridge: when it comes to GP income, how long is a piece of string?

10 March 2011
Just how much does a GP earn? The NHS Information Centre estimates average GP income in 2008-09 (the latest figures available) as £105,300. But any average conceals variations.
Noel Plumridge: feeling the squeeze

3 March 2011
Dupuytren’s contracture is a condition that causes fingers to bend towards the palm. Named after the French surgeon who first described the condition in 1834, it mainly affects men - a reported one in five men aged over 60 - and is most prevalent among people of northern European descent.
Noel Plumridge: trapped in PFI purgatory

24 February 2011
Of the 16 pages of last week’s Managing the Transition letter from Richmond House, the provider side of the NHS occupies a mere three paragraphs. One about the foundation trust “pipeline”, one on separating primary care trusts from their former provider arms and one on encouraging the independent sector.
Noel Plumridge: the true cost of training

17 February 2011
In a transparent, rules based funding system like payment by results, how can we ensure a steady flow of financial goodies to the deserving rich in the London teaching hospitals?
Noel Plumridge: saying the unsayable

10 February 2011
A section of the Health Bill that hopefully won’t often be invoked applies commercial insolvency law to foundation trusts. Section 113 places broke NHS hospitals under broadly the same winding-up regime as bankrupt companies. With falling tariff prices and rigid hospital cost structures, it will probably be tested before long.
Noel Plumridge: the DH's fistful of figures

3 February 2011
The Department of Health’s intent to maintain “grip” on NHS performance during 2011-12 is plain in the technical guidance to the NHS operating framework, issued in late January.
Noel Plumridge: the prospective pinch on pensions

27 January 2011
The government is doing all it can to reduce the value - or, in Treasury-speak, the “burden” - of public sector pensions.
Noel Plumridge: SHAs need to decide their priorities, and soon

19-Jan-2011
One of the more dramatic parts of the 2011-12 operating framework is the withholding, by strategic health authorities, of 2 per cent of primary care trust funding.
'Is the long stay trim a haircut too far?'

13 January 2011
With payment by results, the devil is sometimes in the detail.
Are NHS efficiency savings a dead dog?

17 December 2010
In the golden years of transatlantic airfreight, a turboprop landed in Newfoundland to refuel.
Sharing healthcare costs, pooling healthcare risks

9 December 2010
Size seems to be back in vogue. There are two main reasons for the “big is beautiful” organisational trend, and it is important to distinguish between them, as their impacts on that overriding £20bn NHS savings target are quite different.
Noel Plumridge: Must no deficit mean saying no to delivery?

2 December 2010
According to the recently published Department of Health report on the first quarter of 2010-11, no primary care trusts are forecasting a deficit this financial year.
Parliament, prudence and productivity

25 November 2010
What Commons health committee chair Stephen Dorrell said to HSJ last week was not symptomatic of a tiff between him and Andrew Lansley. More significant issues are coming into play.
Health insurance is a game of poker, against an expert

19-Nov-2010
“NICE is accountable to the public,” Lord Crisp - the former NHS chief executive - advised Parliament last week. “What we don’t need is to import American style private sector rationing where individuals find themselves the victims of decisions made in private by individual insurance companies where nobody is accountable.”
Treading softly on cancer's dreams

11 November 2010
It is good to see old fashioned centralisation is alive and well in sensitive matters.
'Major NHS reforms are driven by the heart, not the calculator'

4 November 2010
Two things become apparent from recent parliamentary exchanges on the cost of anticipated large scale NHS redundancies.
Independent contractors and the NHS

4 November 2010
Are independent contractors really part of the NHS? The answer, traditionally, has been “yes, when convenient; no, when not”.
NHS underspends under the microscope

28 October 2010
It is one of the most common dilemmas of NHS financial management. The trust sets an annual expenditure budget. A budget holder underspends - no doubt for excellent reasons - and wants to carry the unspent balance forward into the following financial year.
'Who will own the NHS?'

21 October 2010
Somewhere between this week’s spending review and the parliamentary debates on the Health Bill, we will learn where the real balance of power between the commissioning board and GP consortia will lie.
Noel Plumridge on axes and accountability

9 September 2010
A useful little word the French have borrowed from English in recent times is un tilt. Derived from pinball, a primitive pre-Super Mario form of entertainment now virtually extinct, it denotes in French a sudden, unforeseen and complete disruption of previous plans. Game over.
A nervous kind of NHS reorganisation

5 August 2010
It’s only a reorganisation, right? Anyone who’s worked in the NHS for a few years has been through reorganisations before.
Noel Plumridge on NHS pay and pensions

17 June 2010
The extra £6bn of spending cutbacks in 2010-11 announced by George Osborne in May appears to have had only a marginal impact on NHS spending, but is unlikely to be true of June’s emergency budget for 2011-12. It’s going to hurt in the months and years ahead.
Capturing the costs of community services

1-Jun-2010
Evidence is essential to designing community services that truly transform care delivery rather than simply shift vulnerable budgets, warns Noel Plumridge
Noel Plumridge on the NHS budget

15 April 2010
Here’s a summary of the financial plan for the English NHS.
Noel Plumridge on the rules of payment by results

4 March 2010
A rules-based system. That was the aspiration in 2004 when payment by results was introduced to England’s NHS.
Noel Plumridge on cutting the NHS cost base

3 December 2009
The Encyclopaedia Britannica defines displacement activity as “the performance by an animal of an act inappropriate for the stimulus or stimuli that evoked it.
Noel Plumridge on medicine’s gender balance

5 November 2009
Supposing it were possible for an observer from 50 years ago to be miraculously teleported into one of today’s NHS hospitals - what would seem most different?
Noel Plumridge on no-frills healthcare

24 September 2009
Who actually likes Ryanair? For the benefit of sustainably minded readers who would not dream of blowing their hard earned moolah on a cheap weekend in Bratislava, the Ryanair pricing model starts with an unfeasibly small headline fare, supplemented by an increasingly imaginative list of charges.
Noel Plumridge on NHS cash in a cold climate

20 August 2009
£15bn - the “efficiency savings” the NHS is being asked to make over the coming three year cycle - is an unimaginably huge sum of money.
Noel Plumridge: the optimism bias uplift

16 July 2009
The crowd from the finance department were relaxing in the Rat and Weasel musing on life’s three inevitables: death, taxes… and the private finance initiative.
Noel Plumridge on caveats for consolidating mental health spending

11 June 2009
A question for commissioners: what is the “right” proportion of your annual funding to spend on mental health?
Noel Plumridge on expenses and exploitation

7 May 2009
It was a cheap Chinese restaurant, just near the bus terminal in a quiet Northern town. Now, I’m partial to Chinese food when away on business, not least because the single male traveller can usually eat a plate of chow mien or special fried rice without feeling awkward and without being tempted by the demon drink.
Noel Plumridge on foundation trusts

2 April 2009
Are foundation trusts here to stay? Five years have passed since the prototypes first saw the light of day. Once controversial enough to bring the government’s very survival into question, how far has this radically new and politically controversial way of organising NHS hospitals simply become normal?
Noel Plumridge on the grim reality of NHS finance

26-Feb-2009
'Look out, not up' is a phrase currently being muttered in the corridors of power at the Department of Health.
Noel Plumridge on security under threat

22-Jan-2009
'What I'd really like for 2009,' said my friend Kate, 'is a man with an enormous pension.'
Noel Plumridge on commissioning for quality and innovation

4-Dec-2008
We now know the 'road test' phase of tariff setting for the English NHS begins on 8 December, when the draft tariff for 2009-10 will at last be published.
Noel Plumridge on a family's care crisis

25-Sep-2008
On Friday morning, Mum was readmitted to hospital. She is 85 years old and vulnerable to infections, with a provisional diagnosis of leukaemia.
Noel Plumridge on a family tragedy

28-Aug-2008
When the mobile phone leaps into life before 8am, it's usually ominous. Yesterday was no exception, with a text from my sister Amy: 'Tony has been in a terrible accident and is fighting 4 his life. Everyone pls pray 4 him.'
Noel Plumridge on problems with PFI accounting rules

31-Jul-2008
Rules, they say, are made to be broken. There was never anything sacrosanct about Gordon Brown's fiscal rule, which has restricted public sector debt to less than 40 per cent of national income.
Noel Plumridge on community tariff appeal

19-Jun-2008
'The biggest black box in the NHS' was how my fellow columnist Simon Stevens last month described the £10bn or more spent by English PCTs on district nursing, therapies and other mainstream community healthcare.
Noel Plumridge on why safety is just a ritual

22-May-2008
A Flybe flight from Southampton to Leeds-Bradford. Through security and reunited with belt and shoes. The flight is called. Walk across the tarmac, climb the stairs and claim seat 4A.
Noel Plumridge on boardroom drama

10-Apr-2008
The setting: A hospital boardroom. A meeting of the executive team of an NHS trust is about to take place.
Noel Plumridge on Darling's discipline

13-Mar-2008
Yesterday's Budget announcement held few surprises for the NHS. As expected. Nowadays, the important public finance figures are published in the autumn, and it would have been disappointing indeed if chancellor Alistair Darling had revisited the NHS assumptions in last October's spending review.
Noel Plumridge on topping up NHS care

6-Mar-2008
It is a long time since NHS care was unequivocally free. Over half a century ago, in the final days of a post-war Labour government that was proud to nationalise not just healthcare but the 'commanding heights' of the British economy - coal, steel, the railways - a certain outspoken Yorkshire politician resigned from prime minister Clement Attlee's cabinet on a point of principle. The introduction of NHS charges, he felt, was one compromise too far.
Noel Plumridge on resource allocation

31-Jan-2008
Buried on page 39 of the 2008-09 operating framework are two bland statements. The first says primary care trusts will receive an increase of 5.5 per cent or £3.8m in revenue allocations in 2008-09, with allocations announced for one year and no changes to PCT baselines.
HSJ Christmas quiz

17-Dec-2007
How well do you recall the ups and downs of the NHS in 2007? Test yourself with HSJ's seasonal quiz. And can you identify Santa's reindeers? Answers below
Noel Plumridge on registering with a GP

13-Dec-2007
Last time I invited responses to two questions: how to choose a GP and why bother now that direct access services are so good?
Noel Plumridge on finding the right GP

8-Nov-2007
Is it worthwhile to register with a GP when there are other alternatives available?
US health: Sicko's grim diagnosis

25-Oct-2007
It may be naive and polemical, but Michael Moore's controversial documentary Sicko reminds us we should treasure the NHS, says Noel Plumridge. Below, Empire magazine's Helen O'Hara reviews the film
Junior doctors face a difficult job market

18-Oct-2007
Already bruised by MTAS, junior doctors are now feeling the effects of market competition - but did the DoH bungle its workforce planning, asks Noel Plumridge, or did it know what it was doing all along?
Noel Plumridge on what the spending review means for health

10-Oct-2007
In an hsj.co.uk exclusive, Noel Plumridge explains how the government's spending round will affect the health sector
Noel Plumridge on lessons from Northern Rock

27-Sep-2007
Healthcare providers should not ignore the difficulties facing other sectors, writes Noel Plumridge
Noel Plumridge on ambition to expand

31-Aug-2007
'Market advocates praise choice, but those within them do their best to create a monopoly'
Noel Plumridge on the cost of a day's work

1-Jan-2007
'Calculate your daily rate. Say it out loud. 'I'm a £500 a day sort of guy''
OPINION

8-Dec-2005
NOEL PLUMRIDGE ON CHRISTMAS WISHES
OPINION

3-Nov-2005
NOEL PLUMRIDGE ON COLD, HARD CASH
ON FLYING INTO TROUBLE

29-Sep-2005
Published: 29/09/2005, Volume II5, No. 5975 Page17
NOEL PLUMRIDGE ON PAYMENT BY RESULTS

18-Aug-2005
OPINION
NOEL PLUMRIDGE ON DEFICIT BY DESIGN

9-Jun-2005
OPINION
NOEL PLUMRIDGE ON EXTENDING PAYMENT BY RESULTS

31-Mar-2005
Published: 31/03/2005, Volume II5, No. 5948 Page 15
BLIND OPTIMISM OR BLINKERS?

6-Jan-2005
Published: 06/01/2005, Volume II5, No. 5937 Page 15
NOEL PLUMRIDGE ON OUT-OF-HOURS CARE PROVISION

2-Dec-2004
OPINION
Save and prosper

28-Oct-2004
NOEL PLUMRIDGE foresees brand-led GP practices
Panic postponed

2-Sep-2004
NOEL PLUMRIDGE on payment by results
Is their number up?

5-Aug-2004
Published: 05/08/2004, Volume II4, No. 5917 Page 24
Acute little idea

8-Jul-2004
finance
An Eye for trouble

10-Jun-2004
NOEL PLUMRIDGE on PFI, 'godsend or albatross'
Hole in one

14-May-2004
Published: 13/05/2004, Volume II4, No. 5905 Page 33
Pay and dismay

15-Apr-2004
NOEL PLUMRIDGE on the ever-increasing NHS staff bill
Capital punishment

18-Mar-2004
Published: 18/03/2004, Volume II4, No. 5897 Page 35
Bother in law

19-Feb-2004
finance
There shall come a great profit

11-Dec-2003
finance NOEL PLUMRIDGE on value instead of economics
Out for the count

13-Nov-2003
NOEL PLUMRIDGE on payment by results
Sound as a pound

16-Oct-2003
The value of money in measuring performance on finance
Open season

4-Sep-2003
finance: Noel Plumridge on why the shared service challenge still applies
Go with the flow

7-Aug-2003
finance: Noel Plumridge on sharpening up reference costing

Alastair McLellan

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