Inept, poor and dishonest: that was the verdict from trust chief executives asked for their views on ministers' handling of NHS finance.

The survey of 97 chief executives from acute, primary care and mental health trusts shows frustration at the perceived failure of ministers to take responsibility for their part in creating the financial challenges now facing the NHS:

  • 79 per cent said the government was trying to dodge the blame for its own financial problems by blaming trusts;
  • 58 per cent believe the NHS would not be facing such severe financial problems if the government did not set such inflexible targets;
  • 87 per cent said ministers use managers as scapegoats to hide their own inadequacies.

When asked to comment about the way ministers have handled the financial problems facing the NHS one chief executive wrote: 'Ministers have been consistently dishonest and disingenuous. they never once stopped to find out what it would cost to implement the latest good idea.'

Another stated: 'Blind panic as ever. No consistency of approach and certainly little support when difficult decisions have to be taken. Bear in mind much of the financial challenges arise from centrally conceived pay schemes for GPs, consultants and Agenda for Change.which were ineptly designed and criminally costed by the Department of Health.despite warnings and advice from the service. The subsequent problems then sit with the NHS to solve.'

One chief executive said the government's track record was 'as bad as anyone possibly could have done. It is hard to imagine greater incompetence.'

Top-slicing and resource accounting and budgeting, in which trusts' deficits are deducted from the next year's budget, were particular causes of frustration aired in the survey.

'Ministers have not listened to advice on historical debt and removal of RAB as advised by the National Audit Office. Further improvement has been hindered for trusts who should have been net gainers under payment by results due to capping. In some cases they have lost their edge, which is ironic as those trusts are the very organisations who should be flourishing in this regime,' wrote one.

'The practice of rewarding failure by top-slicing is totally counterproductive,' another added.

The survey shows that while the NHS plan published by Alan Milburn in 2000 was widely accepted as a good idea, the delay in introducing funding to accompany it diminished its impact.

Overall, 72 per cent of those surveyed agreed that the plan achieved a consensus that is 'totally lacking' in the current reforms and 86 per cent said targets had transformed the experiences of NHS patients.

Other key findings include:

  • 58 per cent said the government wasted too much time before introducing radical reform;
  • 92 per cent believe reforms should have been introduced alongside the five-year funding boost.
  • 90 per cent thought the government needs to hold its nerve and back reconfigurations - but 70 per cent believed that government promises to back tough decisions amount to nothing;
  • 88 per cent thought the government is overly impressed by the private sector;
  • 91 per cent thought the playing field on which the private and public sectors compete was unfair;
  • 26 per cent believe the introduction of private providers into the NHS will end in privatisation.


In their own words: chief executives on...

...how this government has handled the NHS:

  • Lamentable - funding increases like we never dreamed of and we blew it.
  • The early years of spun financial numbers and targets left a continuing legacy of profound distrust about change and achievement. The latter years of growth have been consumed by needless increases in unit costs, suggesting incompetence in getting value for money.
  • Stop pulling the NHS up by the roots to see if it's still alive.
  • Too often knee-jerk.
  • Very significant progress has been made over the last 10 years. There are difficulties but these should not overshadow the good news.
  • Ministers have been consistently dishonest and disingenuous. They never once stopped to find out what it would cost to implement the latest good idea.
  • In the early years the government had a vision. However it has lost its way since the NHS plan.
  • I applaud the sustained investment in the NHS but believe the price for this is unacceptable. Too often policies are changed before they have been allowed to
    bed in.
  • Too little, too late.
  • Too many of your questions are predicated on the 'fact' the NHS faces 'severe financial problems'. If every person in the country had a debt to earnings ration equal to the NHS half the credit companies and banks in Britain would close down.

...the difference a Conservative government would make to the NHS:

  • Faster move to privatisation.
  • Initially probably very little, but in the longer term would probably hasten the demise of the NHS.
  • None! They made an even bigger mess of the NHS over 18 years from 1979.
  • Their love affair with doctors would catch them out very quickly.
  • Could the Conservatives make it worse? Somehow I don't think so.
  • Very little separates them at the moment.
  • I think this Labour government has achieved far more right wing policies with the NHS than a new Conservative government would ever dare.
  • I am unclear what the Conservative policy towards the NHS is.
  • Difficult not to remember the 1980s - not convinced they are committed to a tax-funded system.

...the biggest challenge facing their organisation this year:

  • Finance, finance and finance.
  • Staying credible as a service committed to the public.
  • Our strategic health authority raiding our budgets to bail out overspends in other parts of the patch.
  • The unknown.competition, choice and practice-based commissioning are all significant threats.
  • Agreeing contracts with primary care trusts that are in freefall.
  • Keeping services stable in an increasingly chaotic political context. Managing the cynicism and continuing the improvements. Good performance is rewarded
    with reorganisation and instability.
  • Keeping the confidence of the public - I fear we are losing the battle.