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And these 33 PCTs aren’t the full list as some SHAs have yet to declare their deficits. What about NHS Trusts and FTs? If this is like previous years when the NHS overspent many finance directors will not be reporting potential deficits for fear of SHA ‘intervention’ sometimes referred to as ‘support’ or ‘performance management’. Some will be asked to ‘revise’ their numbers.

It’s absolutely right that acute trusts are seeing patients that could be better seen in the community or even ‘self care’. However, when patients are asked why they went to their local hospital, as McKinsey asked for the south central PCT alliance, the patients said they saw hospitals as a ‘one stop solution’, they had an emotional attachment to their hospital, they were confused or worried. Some patients were informed of the alternatives but referred anyway.

The problem is complex but the patients know best and we don’t ask them enough. This is supposed to be a patient led NHS and not a professional led NHS, isn’t it? All of this of course assumes PCTs can commission which successive reports/assessments have demonstrated only a handful are even getting close. Is that because they don’t want to or more likely because they have too many targets / priorities / demands…