As anyone who saw All the President’s Men at an impressionable age will tell you, the first rule of investigative journalism is “follow the money”.
Unfortunately, that suggests ace reporters Woodward and Bernstein would have had a miserable time covering the current NHS reforms.
‘It’s no surprise the finance chiefs are still trying to work out which pots of cash have wound up in the wrong place’
It seems increasingly apparent, as the newly formed clinical commissioning groups count their allocations and sort through their stacks of inherited contracts, that there may be no one who can say exactly where the money should have gone, where it will go, or − in some cases − where it has gone.
Let’s recap the basic financial task involved in the current NHS reorganisation. The thousands of contracts that were held by 151 primary care trusts until 2013-14, had to be accurately divided between 211 newly formed CCGs, 152 local authorities (which took over public health), and NHS England (which took over specialised services and primary care). The aim was to ensure no one was left − on day one of the new system − with more or less money than they would previously have had to pay for the services they were responsible for.
The challenge was not helped by the fact that large areas of primary care trust spending − such as mental health and community services − were on “block” contracts, and commissioners could not necessarily say precisely how much of that spend was used by each CCG’s population. Nor was it helped by a major change in the definition of specialised services just months before the handover.
‘Can they design a system which is both fair and doesn’t cause such huge disruption that damages patient care?’
So it’s no surprise that, in the first days of the new system, the finance chiefs are still trying to work out which pots of cash have wound up in the wrong place. Nor is it surprising to find many new commissioners suspect they’ve been short-changed.
The initial focus of this kind of suspicion was the £12bn allocated to specialised commissioning but, as this week’s story about Eastern Cheshire shows, there are CCGs with broader doubts about the accuracy of the allocations process. It is doubtful that Eastern Cheshire CCG is the only such case.
When concerns emerged in 2011 about the system’s capacity to accurately split up PCTs’ budgets, the then PCT Network director David Stout estimated many would need to make “pretty crude estimates” about around 65 per cent of their spending. In these circumstances, he said, the question was: “Can they design a system which is both fair and doesn’t cause such huge disruption that the implications of that damage patient care?”
The complexity of the task facing new commissioners, as they seek to pool risk and establish whether and where allocations were inaccurate, is such that it may be a long time before we know the answer.