NHS England chief executive Sir Jim Mackey seems confused. On September 19 he sent out a boisterous, upbeat circular to chief executives and chairs of all 42 Integrated Care Boards (ICBs), trusts and foundation trust, which began by asserting that progress since April “has been astonishing.”
Aside from some dodgy claims about (minimal) progress on waiting times “in electives, cancer and for emergency care” (see linked article on performance) this assessment appears to be based on apparent improvements in the financial plight of the various NHS bodies, many of which had to aim for extremely high levels of “efficiency savings” to get anywhere near a plan for a balanced budget in 2025/26.
Many of these plans were based on assumptions of achieving large-scale job losses – as demanded by Sir Jim back in March as he took over the top job in NHS England. He called then for huge cuts in staffing of ICBs and trusts to be achieved by December, alongside the target 50% cut in staffing of NHS England itself.
But it was always doubtful whether the Treasury would stump up the additional £1 billion or more needed to cover the redundancy costs of potentially thousands of axed posts, including very senior managers. The cash limits for NHS commissioners and providers are so tight for this year that without the job losses many of the so-called “efficiency savings” and balanced budgets were simply unachievable.
In June, after two months of uncertainty, the Treasury explicitly turned down a request for additional funding to cover exit packages in 2025-26, and no central funding pot is therefore available. In August it became clear that a number of ICBs were holding back on redundancy announcements, which they could only afford to carry through if the Treasury helped foot the bill for pay-offs.
And after a summer in which increasing numbers of staff have been left dangling, unsure of whether or not their jobs would be axed by Christmas, Mackey on September 10 publicly rowed back on his previous tough talk, insisting to MPs that he never promised funding would be available.
Nine days later Mackey’s dynamic opening paragraphs of the 4-page circular to NHS commissioners and providers accordingly tailed off into increasingly evasive phrases, noting that despite their improved “professionalism and grip” many organisations are already falling behind with planned efficiencies and grappling with “unplanned workforce costs” – without mentioning the lack of cash to carry through large-scale job cuts.
And just four days later, on September 23 Mackey was telling a meeting of the NHS England board that if the Treasury does not cough up the extra funds within weeks, the NHS will have to turn to a “plan B.” Many NHSE Board members, like many local NHS chiefs across England, alongside the staff they are managing – must have wondered just what Sir Jim had imagined might have been Plan A, given that he has known for months that the redundancy cash pot would not be forthcoming. Nobody knows what a newly-hatched Plan B might entail.
In other words all of the plans which Mackey’s circular had boasted were set to balance the books of all 42 ICBs this year were based on false assumptions. The tight-fisted Treasury has left almost every ICB staring down the barrel of a hefty deficit, whether they cut the jobs or not. If they swing the axe, they have to foot the bill for redundancies – and struggle to maintain services and cover the gaps in staffing: but if they keep the staff in post, they have to cope with a wage bill that is well beyond their means in 2025/26 and an even bigger problem next year.
But it gets worse. Sir Jim announced in the circular that he and his trusty team will be carrying out “mid-year reviews” with ICBs and providers … over the next 6 weeks. He is demanding that each body prepares a suitably convincing story by the end of the week, and sticks to it, warning local health chiefs (some of whom had expected to have received large pay-offs and to have ridden off into the sunset before any scrutiny revealed the holes in their plans):
“You should prepare for this scrutiny, ensuring that, at organisation and system level, you are ready to articulate a clear and credible financial position for the remainder of this year which delivers operational standards.”
Sir Jim of course knows as well as the people he will be putting through the mill that the credibility of many of the job cuts was tenuous, at best, even before the Treasury pulled the rug from under them. Almost none of the public announcements of impending job losses have given any specific details of which jobs are to be axed, precise numbers of jobs, or savings targets – indicating there was no clear plan.
Some trusts were even relying initially on voluntary departures – which threatened to leave a chaotic pattern of gaps in staffing that pose a real threat to standards, safety and access to care.
Some had even announced the cuts were to include clinical staff, opening up the horrific possibility of one or more repetitions of the ill-conceived Mid Staffordshire hospital spending cuts in 2007-8 when nursing and doctors’ posts were cut in the hope of saving £10m to secure foundation trust status … with famously disastrous effects.
But there is now a nod and a wink to bosses suggesting maybe a strong-sounding bluff might do the trick, and get them through the review: Mackey’s circular on September 19 tacitly admits he is ready to be convincingly hoodwinked:
“Positively, all but one system has confirmed their expectation that they can deliver the operational performance targets set for this year within their financial envelopes, and so, through mid-year reviews, we look forward to exploring assumptions.”
This was written six weeks and more after reports had reached the Health Service Journal on the growing number of local plans for cash saving through job cuts that had been shelved – some even postponed to next year, awaiting the Treasury’s final word. So exactly what assumptions is Mackey expecting to hear and explore?
Four days later Mackey and NHS England heard a very different report on finances: only a minority of systems were on track just four months in to the year: only “Sixteen [out of 42] systems and 44% of providers” had “delivered to plan at month 4.”
Behind all the pretence that all is well, and that the plans that NHS England bullied trusts and ICBs into drawing up are really working out, everyone really knows that this is not the case at all.
Mackey the hard man, who said he was determined to drive through the elimination of deficits in a single year is really looking for a figleaf to hide his embarrassment … while tens of thousands of NHS staff up to very senior level are left uncertain how long they may have a job, and frustrated at the lack of resources to run the NHS properly.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
NHS England chief executive Sir Jim Mackey seems confused. On September 19 he sent out a boisterous, upbeat circular to chief executives and chairs of all 42 Integrated Care Boards (ICBs), trusts and foundation trust, which began by asserting that progress since April “has been astonishing.”
Aside from some dodgy claims about (minimal) progress on waiting times “in electives, cancer and for emergency care” (see linked article on performance) this assessment appears to be based on apparent improvements in the financial plight of the various NHS bodies, many of which had to aim for extremely high levels of “efficiency savings” to get anywhere near a plan for a balanced budget in 2025/26.
Many of these plans were based on assumptions of achieving large-scale job losses – as demanded by Sir Jim back in March as he took over the top job in NHS England. He called then for huge cuts in staffing of ICBs and trusts to be achieved by December, alongside the target 50% cut in staffing of NHS England itself.
But it was always doubtful whether the Treasury would stump up the additional £1 billion or more needed to cover the redundancy costs of potentially thousands of axed posts, including very senior managers. The cash limits for NHS commissioners and providers are so tight for this year that without the job losses many of the so-called “efficiency savings” and balanced budgets were simply unachievable.
In June, after two months of uncertainty, the Treasury explicitly turned down a request for additional funding to cover exit packages in 2025-26, and no central funding pot is therefore available. In August it became clear that a number of ICBs were holding back on redundancy announcements, which they could only afford to carry through if the Treasury helped foot the bill for pay-offs.
And after a summer in which increasing numbers of staff have been left dangling, unsure of whether or not their jobs would be axed by Christmas, Mackey on September 10 publicly rowed back on his previous tough talk, insisting to MPs that he never promised funding would be available.
Nine days later Mackey’s dynamic opening paragraphs of the 4-page circular to NHS commissioners and providers accordingly tailed off into increasingly evasive phrases, noting that despite their improved “professionalism and grip” many organisations are already falling behind with planned efficiencies and grappling with “unplanned workforce costs” – without mentioning the lack of cash to carry through large-scale job cuts.
And just four days later, on September 23 Mackey was telling a meeting of the NHS England board that if the Treasury does not cough up the extra funds within weeks, the NHS will have to turn to a “plan B.” Many NHSE Board members, like many local NHS chiefs across England, alongside the staff they are managing – must have wondered just what Sir Jim had imagined might have been Plan A, given that he has known for months that the redundancy cash pot would not be forthcoming. Nobody knows what a newly-hatched Plan B might entail.
In other words all of the plans which Mackey’s circular had boasted were set to balance the books of all 42 ICBs this year were based on false assumptions. The tight-fisted Treasury has left almost every ICB staring down the barrel of a hefty deficit, whether they cut the jobs or not. If they swing the axe, they have to foot the bill for redundancies – and struggle to maintain services and cover the gaps in staffing: but if they keep the staff in post, they have to cope with a wage bill that is well beyond their means in 2025/26 and an even bigger problem next year.
But it gets worse. Sir Jim announced in the circular that he and his trusty team will be carrying out “mid-year reviews” with ICBs and providers … over the next 6 weeks. He is demanding that each body prepares a suitably convincing story by the end of the week, and sticks to it, warning local health chiefs (some of whom had expected to have received large pay-offs and to have ridden off into the sunset before any scrutiny revealed the holes in their plans):
“You should prepare for this scrutiny, ensuring that, at organisation and system level, you are ready to articulate a clear and credible financial position for the remainder of this year which delivers operational standards.”
Sir Jim of course knows as well as the people he will be putting through the mill that the credibility of many of the job cuts was tenuous, at best, even before the Treasury pulled the rug from under them. Almost none of the public announcements of impending job losses have given any specific details of which jobs are to be axed, precise numbers of jobs, or savings targets – indicating there was no clear plan.
Some trusts were even relying initially on voluntary departures – which threatened to leave a chaotic pattern of gaps in staffing that pose a real threat to standards, safety and access to care.
Some had even announced the cuts were to include clinical staff, opening up the horrific possibility of one or more repetitions of the ill-conceived Mid Staffordshire hospital spending cuts in 2007-8 when nursing and doctors’ posts were cut in the hope of saving £10m to secure foundation trust status … with famously disastrous effects.
But there is now a nod and a wink to bosses suggesting maybe a strong-sounding bluff might do the trick, and get them through the review: Mackey’s circular on September 19 tacitly admits he is ready to be convincingly hoodwinked:
“Positively, all but one system has confirmed their expectation that they can deliver the operational performance targets set for this year within their financial envelopes, and so, through mid-year reviews, we look forward to exploring assumptions.”
This was written six weeks and more after reports had reached the Health Service Journal on the growing number of local plans for cash saving through job cuts that had been shelved – some even postponed to next year, awaiting the Treasury’s final word. So exactly what assumptions is Mackey expecting to hear and explore?
Four days later Mackey and NHS England heard a very different report on finances: only a minority of systems were on track just four months in to the year: only “Sixteen [out of 42] systems and 44% of providers” had “delivered to plan at month 4.”
Behind all the pretence that all is well, and that the plans that NHS England bullied trusts and ICBs into drawing up are really working out, everyone really knows that this is not the case at all.
Mackey the hard man, who said he was determined to drive through the elimination of deficits in a single year is really looking for a figleaf to hide his embarrassment … while tens of thousands of NHS staff up to very senior level are left uncertain how long they may have a job, and frustrated at the lack of resources to run the NHS properly.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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