Alarm bells sound as financial scrutiny falls victim to the cuts
Amid the sound and fury surrounding the abolition of the Audit Commission there was little comment on how it would affect the NHS.
If ever there was a time to ensure that financial scrutiny within the NHS was as robust as possible, this is surely it. Areas of efficiency and waste need to be identified and learning spread as a vital ingredient of achieving the £20bn savings target.
If ever there was a time to ensure that financial scrutiny within the NHS was as robust as possible, this is surely it
The financial impact on services affected by reconfiguration needs to be thoroughly examined, as does the health of trusts being accelerated towards foundation status. Spending habits of primary care trusts - distracted and demoralised - need to be watched, and then there is the fantastically thorny issue of who and how you audit GP commissioning consortia.
Overarching all of this is the need to maintain a consistent approach to NHS financial management, in part to reassure the Treasury that the only ringfenced major department is spending its money wisely.
With the commission’s impending demise, and Monitor becoming the new economic regulator, this burden is settling firmly on the Department of Health’s shoulders and chief executive Sir David Nicholson’s “national management service”.
Given the DH is going through its own slimming exercise, this seems a dangerous piece of risk management. It will also weaken independent examination of the financial implications of the new policy.
Last week, HSJ warned of the dangers of no longer monitoring the quality of PCT performance. Now there seems to be a real danger that, through confusion about future arrangements and the distraction of competing policy, financial scrutiny may reduce too. That should alarm everyone with an interest in the immediate future of the NHS.
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Readers' comments (5)
Anonymous | 19-Aug-2010 12:31 pm
If we had competent managers, directors and boards in the NHS who acted in the public interest rather than their own interest we wouldn’t need all this scrutiny, oversight and regulation. This just shows how much ineptitude of management and financial control there is in the NHS, and that inept money wasting managers and boards need to be eliminated from the NHS as soon as possible, so the rest of us are freed from the bureaucratic overload.
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Anonymous | 19-Aug-2010 12:44 pm
Ah - self regulation eh? The voice of sanity, my eye! Is this comment based on a view that the much vaunted private and investment sector is somehow more competent and better regulated than the public sector? If it is, I'd question not just which country youve been living in for the past three years but also which planet...
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Joe Bloggs | 19-Aug-2010 5:21 pm
In support of the first post: We have this level of scrutiny because the previous government believed in control as the principle measure of their success. They convinced us that £63bn a year needed to be spent on quangos most of which were organisations offering scrutiny or were a body not directly delivering services. What country could afford this?
The previous Government convinced us that scrutiny was required because these unaccountable faceless bureaucrats running PCTs, SHAs, DH and Trusts could not be trusted to spend our money wisely. But the AC failed to check this and the NHS wasted billions on everything from poorly negotiated GP contracts through to a PCT buying a £400k yacht. The provider Trusts are the only part of the NHS that has even got close to accountability.
Accountability should rest with statutory bodies. The issue is many statutory bodies don't do anything (hence many are going). Those that remain need freedom and greater public accountability. That's what's happening and it's certainly better than control and wasted £billions offered by the Labour Government.
As for AC specifically, their conflict of interest with DH and their need to be 'independent' led to their demise and general opinion around here is this was a long time coming.
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Anonymous | 19-Aug-2010 5:26 pm
ANON @ 12.31
"the rest of" - that'll be doctors then. It's called democracy mate, not distrust. Scrutiny, oversight & regulation go hand-in-hand with any large public-sector organisation - with the NHS it was, up 'til now, to help patients stand up to the Lancelot Spratts of the NHS.
You might as well say that if we had a Govt that everyone trusted we would n't have to bother with elections.
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Anonymous | 20-Aug-2010 3:24 pm
Public service is being deliberately driven into the ditch in cull of Stalinist proportions. Who will benefit? The conservatives' fat cat mates who waiting in the wings to feast on the carcass. The accountancy firms with their risk based approach to audit (check the insurance premium and sign off the accounts) will be the first to benefit.
Sacking a bunch of managers is politically motivated to acheive this end and will not save a pound. It will increase the drain of knowledge from NHS to the private Health Sector. The NHS will waste billions this year as in all others as it scrambles to hide embarrassing surpluses with fewer controls to stop wasteful schemes being devised. Who is going to stop that happening? Why would they?
The monumentally missed point is that PCTs do exactly what their political and bureaucratic masters expect them to do - spend every penny they get their hands on and get as many pennies as they can. Use it or lose it - this is the golden rule of public finance. In good times and in bad.
The sad thing is that, like beasts, we are more interested in blood letting than fixing the problem. I am convinced it can be by promoting the frugal "bureaucrats" not the profligate, self promoting ones.
Ronald Regan gave the people back their taxes in the 1980's. We could pay off the deficit.
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