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Theresa May’s promise of a long term funding plan for the NHS has finally offered some light at the end of the tunnel.
The service will be scathed, battered and bruised when it gets there, but it will get there.
The shape and generosity of the plan at the other end will, of course, be another story, for which we will have to wait.
Between now and then, it will be necessary to fully demonstrate the financial and demographic pressures facing the service – and convince ministers a substantial funding injection can be effectively spent.
While the Five Year Forward View pointed in the right direction and achieved a broad consensus, the funding element was opaque and insufficient.
The 2015-16 “reset” aimed to bring clarity and control but was devised on the flawed basis of a £1.8bn provider deficit.
The actual reported overspend that year was £2.5bn, with the underlying position at £4.3bn. A slight improvement came in 2016-17 but the deficit got worse in 2017-18.
Failing the bleep test
The damage has not just been felt on the bottom line.
The inadequacy of the forward view settlement and the reset miscalculation created wholly unrealistic expectations around the NHS’s financial performance and a corrosive culture of pretence.
Many trusts are in a cycle of failure because of the impossibility of the task. They have long failed the “control total” bleep test, and yet the test is still running at the same speed.
The likes of King’s College Hospital Foundation Trust, Lancashire Teaching Hospitals FT, University Hospitals of North Midlands Trust, and Southport and Ormskirk Hospitals Trust are having to reject targets that require absurd cost improvement plans of 10-15 per cent, and forego access to sustainability funding.
Even with the help of some extra cash, the requirement to get the overall trust sector back into financial balance in 2018-19 (by delivering average CIPs of around 4 per cent) looks overly ambitious and doomed to fail.
All the NHS can do is attempt to get close and hope another failure won’t bolster the argument of those who want to keep the service on rations.
When it comes to setting the long term plan, the suggestion from NHS Providers to involve frontline organisations in the planning discussions seems essential. A framework agreed privately and announced to the sector by the Treasury, Department of Health and Social Care, and NHS England/Improvement is not going to work.
For local NHS organisations, greater involvement in the planning will increase the chances of a realistic funding envelope and performance expectations.
For the government, which this time must get the NHS onboard with the plan and funding envelope attached, it would ensure local leaders are truly signed up and accountable.
- Department of Health and Social Care (DHSC)
- Foundation Trust Network (NHS Providers)
- Government/DH policy
- KING'S COLLEGE HOSPITAL NHS FT
- LANCASHIRE TEACHING HOSPITALS NHS FT
- NHS Improvement
- Philip Hammond
- SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST
- Theresa May
- UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST