The National Audit Office's finding that health authorities and trusts managed to reduce their collective deficit by£230m last year is good news in a limited sort of way (see news, page 7). From another perspective, it means that£230m of last year's government allocation simply was not spent on healthcare.
This and other unexpected demands on resources - chancellor Gordon Brown's£500m-a-year increase in the bill for NHS employers' pension contributions, the Department of Health's decision to abandon HAs and trusts over millennium staff payments, and so the list carries on - goes a long way to explaining why it is that ministers can shout so loudly about their investment in modernising the NHS when the experience of those working on the ground suggests that money is tight.
Parts of the health service have found it tough getting themselves back into balance. They have had little thanks for their efforts - and, it should be said, little help from ministers who have sometimes sat for an unconscionable time on closure decisions despite the problems this causes. But it was the right thing to do - not least because financial pressures show no signs of easing.
In the short term, the NHS Confederation is right: health secretary Frank Dobson could help by releasing what remains unallocated of his modernisation fund. Managers are becoming fed up with constant pressure to bid for small packages of cash, and the advantages to be gained from the novelty of such an approach swiftly diminish.
In the longer term, Mr Dobson needs to rely more on his own instinct for open and honest assessment of what is and what is not possible, where his bluntness can be a distinct if uncomfortable asset, rather than on the tiresome spin of double and treble counting, which merely raises unreasonable expectations. The NHS is not in a crisis - financial or otherwise. But it is certainly as possible to talk it up into one by those means as it is, through denigration and shroud-waving, to talk it down into one.
A force to be reckoned with
Lack of joint working between police and health services leads to risk
The absence of clear national guidelines and mandatory training for police officers in how to deal with the mentally ill people they will inevitably come across in the course of their work should be a matter of great concern to the NHS (see news focus, pages 9-10).
High-profile incidents such as that which led to the death of WPC Nina Mackay inevitably focus attention on the tiny number of cases in which mentally ill people become a danger to others; all too often, mentally ill people themselves are at risk because the police lack either the knowledge or the facilities they need to cope with crises.
And yet, while many police forces acknowledge that officers on the front line face a growing problem, few appear ready to offer the help and support they need to deal with it appropriately. Alarmingly, a quarter of all police forces provide no training on medical issues at all, let alone on mental health, to custody officers.
Part of the answer lies in good joint working, and initiatives such as those pioneered by South Birmingham Mental Health trust and City and Hackney Community trust are a start. But unless health services are proactive at local level and police forces responsive, that can only be part of the solution. The real problem is the independence enjoyed by police forces. And while there may be other good arguments for preserving that freedom from central control, this is one area where it does nothing but harm.
In view of the working relationship developed by the Department of Health and the Home Office in reviewing mental health law - and the translation of Paul Boateng from one to the other - this is an issue that health ministers could usefully put on the 'joined-up government' agenda.
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