Today brings the, not unexpected, news that NHS providers have overspent by £2.45 billion in 2015/16. This brings back memories to me of a similar event in 2006 when I was part of the turn-round teams brought in to investigate a deficit of around £1bn. As a consequence of this, the chief executive of the NHS, Nigel Crisp, fell upon his sword.
Today’s deficit is two and a half time the size of the 2006 deficit so what will happen now. Well we can be certain that the current chief executive, Simon Stevens won’t resign – he hasn’t been in the job that long and can’t be held responsible for this.
In the longer term, there are tough decisions to make about the future of the NHS. Clearly it is never going to generate the level of efficiency savings expected of it but who, in their right mind, ever thought it could. The culture of the NHS just isn’t focused strongly enough on efficiency and value for money and the Francis Report with its (understandable) emphasis on patient safety coupled with a culture of risk-averseness has made the situation worse. In the longer term, it seems to me that the Chancellor will have to stump up more cash or suffer a catastrophic reaction from the electorate. After all, the NHS is said to be the national religion and UK spending on publicly financed healthcare as a % of GDP is well below Western European levels. Even Greece spends a larger part of its GDP than we do on health.
In the short term what can we expect? I suggest:
· Lots of attempts to alter accounting practices in order to reduce NHS Trust deficits and help the Department of Health to avoid breaching its vote – a capital offence in Whitehall
· The decimation of health promotion and public health care
· Big reductions in capital investment to shore up the revenue side
· Mothballing of innovative projects
· Cutbacks in training and development
· Freezing of vacancies
· Cutbacks on buildings maintenance etc
How do I know this? Well we have been her many times in the past but not, perhaps, on the same scale as at present. Clearly this is not a sustainable situation but short-termism rules in Whitehall