Daily Insight: ‘Why would anyone submit a balanced plan?’

The latest bailout for cash-strapped commissioners and trusts has prompted some strong views from irate finance chiefs.

Just six weeks before the end of the financial year, NHS England is injecting nearly £700m, thought to be targeted at integrated care systems that set deficit budgets at the start of the year.

The money is not free and will have to be repaid in later years (although no one really believes the balance will ever be cleared).

Yet some leaders view the bailout as just the latest example of the craziness of NHS finance. By giving the cash to areas that submitted deficit plans rather than those that tried to balance the books, they argue NHSE is “rewarding failure”.

The timing is also suboptimal, coming as financial plans for 2024-25 are being drawn up.

Again, disenchanted finance professionals see the move as further evidence that the planning round is not about accurate projections but instead a “bidding process” in which systems hold out for money they know is being held centrally.

NHSE needs to “come out really strongly on what the consequences are for these systems,” one ICB boss said. “Otherwise, why would anyone submit a balanced plan next year?”

Still a job half done

The ambulance sector has historically been out on its own in the NHS. Decades ago, many ambulance men – and it was generally men at that time – probably felt a closer affiliation to the police or fire brigade than to NHS staff in hospitals or out in the community.

Changing that has taken a generation but is still a job half done. Staffing in ambulance trusts has evolved with many younger female staff and the growth of the paramedic profession. Culture has not kept up – and can still feel markedly different to the rest of the NHS.

That’s why Siobhan Melia’s review is so important. Ms Melia, who was South East Coast Ambulance Service Foundation Trust interim CEO for a year, was shocked by her experience. Her report proposes sensible measures to address many issues.

However, it is fair to say many ambulance leaders have already recognised there is a problem and have taken action to address it. Last year’s Ambulance Leadership Forum was marked by its focus on such issues and inclusivity.

But Ms Melia’s report will reinvigorate their efforts and ensure that integrated care boards and NHSE have skin in the game as well.