Daily Insight: Surplus sleight of hand

The NHS last year set itself a tough task – to spend the autumn and winter continuing to combat covid while also amping up elective and cancer work to try to grind through the towering backlog of patients waiting for treatment.

The pandemic did not play ball and the health service along with the rest of the country had to scramble to suppress and address the second and third waves of covid. This means the NHS rather overestimated its costs, leaving it with a surplus for the year.

Logically, one might assume this would be merely rolled over into 2021-22. It would be a welcome titbit for the service, given the privations of years past and the seemingly endless queue of patients waiting for their elective or cancer treatment, and mounting numbers coming to the doors of emergency departments.

However, the worry is that the Treasury and the rest of Whitehall will not look favourably on such largesse.

Therefore, finance directors are now looking to minimise surpluses on paper by using various accounting treatments. As one FD told us, “there are likely to be lots of trusts now with massive cash balances but limited surpluses, due to lots of accruals of estimated invoices or commitments”.

Going against the flow

More than 120 never events have been linked to devices which NHS England now wants all trusts to remove.

NHSE is drafting a national patient safety alert urging trusts to remove all air flowmeters from wall medical gas outlets.

It comes after incidents of patient collapse, intensive care unit admissions and ventilator dependency followed “unconscious errors” by staff, which have been linked to the devices.

According to NHSE documents, taken down from its website after HSJ approached NHSE for comment,  the never events often went undetected “for some time”, even when other staff responded to deteriorating patients or took over their care. 

The safety alert, expected to be published next month, is likely to call for the “wholescale removal” of the devices.