Cowper’s Cut: Happy National Lying About the NHS Deficit Day!

There are certain moments in the NHS calendar that are as pivotal as they are festival. A glorious recent addition to the canon is National Lying About The NHS Deficit Day, which I’m sure we all enjoyed celebrating this week. 

NHS Improvement signally failed to blush when emitting its misleading quarter four data release. There have been Booker prize winners containing less fiction than can be found in that take on the NHS’s finances.

NHS Improvement would like the gullible to believe the following: “The sector ended the year with a deficit of £960 million; £464 million above the ambitious plan set for the year, but substantially below the deficit of £1,281 million deficit reported at the end of Q3. This deficit represents only 1.2% of turnover, with more than two-thirds of providers finishing the year on target or better”.

Members of the reality-based community found a wry smile playing around the corners of our well-chiselled features. We looked at the new report on NHS funding flows from ex-health secretary Alan Milburn, PwC and the Healthcare Financial Managers’ Association, which you can get here.

We nodded so vigorously at Nuffield Trust-er and ex-HSJ-er Sally Gainsubury’s analysis of the financial fibbing by NHS Improvement that whiplash injuries are bound to ensue. (Perhaps, we can get one of the NHS specialist law firms to sue NHSI on our behalf?)

As I pointed out in last week’s column, the Nuffield Trust and others have been pointing to the actual underlying (emphasis on the lying) NHS deficit being around the £4bn mark.

Why lie?

One of the great lost expressions from the days of standing football terraces is “don’t piss down my back and tell me it’s raining”.

So, why the arms-length relationship with the reality of NHS finances? WTAF does NHS Improvement think it’s going to achieve?

Here come the Treasury Munchkins, ladies and gentlemen: this pointless sub-Whitehall financial farce is about trying to impress the Treasury Munchkins.

The thinking (if we can even call it that) goes along these lines: “Oooh, we mustn’t upset ‘Treasury’. They have hidden voodoo powers to make billions magically appear to bribe Northern Ireland’s Democratic Unionist Party if the government unnecessarily spuffs its majority on a disastrous early general election.

“So, you know, ‘Treasury’ are, like, really, really powerful and we mustn’t do anything to offend them. So, if they say the NHS has to get the deficit apparently down by any means possible, that’s like the Word Of God!” 

Treasury in ‘just government banking function; not actually Gods’ shock

What a load of hog-whimpering bollocks. I’ve said this before and I’m pretty sure I’ll say it again: Treasury is the banking function of the government. It is there to get money in tax and help allocate it for spending. Not investment – that is pseudo-economics. It is spending: public spending on things the public demonstrably wants and values.

And the NHS system leaders have gone all Stockholm Syndrome with the Treasury Munchkins’ inflated self-image. Why? The “Treasury” manifestly hasn’t got a clue about health or the NHS, judging from the many reported comments I’ve heard from people who discuss this with them regularly.

So, we shouldn‘t engage in this lying for a variety of reasons.

First, it gives comfort to the tendency of some politicians to blatantly lie about NHS finances. We had the fictional and time-travelling “£10bn extra for the NHS”; and the “Simon Stevens got all the money he asked for” was another classic of the genre. And unchallenged lying bleeds through partisan media to a public most of whom are not public policy geeks, you’ll be stunned to hear.

So yeah, that’s bad.

Second, it props up a variety of nonsense ideas. Like the 6 per cent interest rate charged by the Department of Health and Social Care to providers in financial special measures who need to indulge in such wasteful fripperies as paying their staff. I mean, why stop at just just 6 per cent? Why not go all Wonga on it, and charge 1,000 per cent? The already-under-financial water NHS could probably pay off the national debt in short order.

We also need to stop the incentivisation of lying within the system. Again, I wrote last week that “the incentivising of financial lying in control totals has not really been a high point of recent health policy”. There is a lot still to emerge about this and it’s a totally avoidable problem.

Third, Nolan. Forgotten so soon: the Nolan Principles remain one of the soundest guides to how people doing the difficult jobs in the public sector should conduct themselves.

And if anyone thinks that by lying about the NHS deficit (or colluding in so doing), they are embodying integrity, objectivity, accountability, openness, honesty and leadership, they are deceiving themselves spectacularly and to no good end other than making some politicians who’ve decided to underfund the NHS relative to demand growth.

What a depressing week. Not improved by the normally-sensible shadow health secretary Jonathan Ashworth briefing The Guardian that Labour is planning a fresh structural redisorganisation of the NHS. (Obviously, there’s some Corbynista cobblers about banishing privatisation and renationalising the NHS thrown in there because the Labour Party’s grip on the reality-based community doesn’t really exist these days.)

I thought Ashworth smart enough to realise that if he actually gets into office, the structures matter a lot less than leadership and clear direction and priorities. Just look at how NHS Commissioning Board boss Simon Stevens has completely ignored the 2012 Act whenever it suits him, with utter impunity. Or at how much preventing of anti-competitive behaviour the Monitor bit of NHS Improvement’s been doing in recent years.

As La Rouchefoucauld put it, “hypocrisy is the homage vice pays to virtue”.