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New NHSI chief revealed

Ian Dalton CBE is the new chief executive of NHS Improvement.

Leaving aside issues like his pay and his four month stint as boss of Imperial College Healthcare Trust for now; he is eminently suited to the role.

With a long record leading health systems and a spell as deputy chief executive of the NHS Commissioning Board before it became NHS England, Mr Dalton is well qualified.

But not many people are jealous – the NHSI job will be very pressured over the next two years.

Lots of hospital chief executives turned the job down as undoable.

Let us count the ways…

It seems highly likely that the provider sector’s Q3 results will show the same sort of downturn they did last year, and from a lower base than last year.

This is before we see more trusts reveal the kinds of financial and financial governance problems seen at Oxford, King’s and Lewisham.

Operationally, the situation is grim.

Even by the flattering “all types” A&E measure, performance continues to get further away from even the lowered targets the service now aims for.

The elective waiting picture is also difficult and getting worse.

The slender budget increase last week will make things even more uncomfortable for Mr Dalton than they were for Jim Mackey.

Few think the £1bn to recover the elective backlog is enough. The A&E £600m is given even shorter shrift.

But the government considers those issues taken care of with its extra money.

The crunchy, publicly visible problems the service will face over the next four months will be occurring at the hospital, ambulance and mental health trusts Mr Dalton is responsible for from Monday.

The tension between the government’s version of reality and reality’s version of reality will be the tightrope he walks.

Reality bites

First NHS Improvement, and now NHS England. The regulators are getting real on the finances.

Typically, NHSE’s finance reports set out the formal forecast position and the risks involved without seeking to cause too much alarm.

But despite the official forecasts pointing to a combined CCG deficit only half as bad, NHSE’s chief financial officer Paul Baumann has warned that the likely year end deficit will be more than £500m.

This is explained by the fact that CCGs are not allowed to go changing their forecasts willy nilly – they need to follow a formal process and have it signed off by NHSE.

Only 14 CCGs have so far done this, but Mr Baumann’s warning suggests there are many more in the pipeline.

The warning comes after last week’s budget settlement, in which new funding was announced, but also earmarked for reducing waiting times for emergency and elective.

The NHSE report also mirrors the more pessimistic tone being taken by NHSI, which sounds like it’s given up completely on meeting the planned £496m deficit for the provider sector.