“The floggings will continue until morale improves” appears to be NHS England’s management approach as they turn up the heat on Integrated Care Boards and NHS trusts in their efforts to squeeze down a collective deficit projected as £3 billion.
They will have been encouraged to crack the whip by Health and Social Care Secretary Wes Streeting’s declaration of “total confidence” in NHSE chief executive Amanda Pritchard just days before the election.
However their efforts to squeeze down spending to the tight limit set by Tory Chancellor Hunt are taking place despite the warnings from think tanks that the level of spending is simply set too low for the new government to be able to deliver on its promises, and will inevitably lead to a decline rather than a revival..
Streeting’s endorsement came after NHSE issued new guidance at the end of May which demanded local Integrated Care Systems (ICSs) “must live within its government-mandated spending limits”.
The guidance incorporates a new, perverse incentive system, which penalises the most financially-challenged ICSs that have not been able to set or stick to a balanced budget, by cutting their allocation of capital for maintenance and renewal of buildings and equipment by up to 10 per cent. The same scheme offers rewards of extra capital for those that are already able to cope within their budgets.
The HSJ is now reporting examples of trusts with the largest bills for backlog maintenance which are seeing their allocation of capital cut, creating new and growing threats to the quality and safety of patient care.
The HSJ article singles out Guy’s and St Thomas’ Foundation Trust and Nottingham University Hospitals as high profile victims of this policy, “second and third highest estimated costs to bring estates back to a suitable working condition, at more than £400m each.”
Other trusts affected are Manchester University FT and Mid and South Essex, while additional ICSs facing capital cutbacks are Staffordshire and Stoke-on-Trent, South East London, South West London, Herefordshire and Worcestershire, and Lancashire and South Cumbria
Some of these same trusts and systems will also come under the cosh as a result of NHSE instructing nine of the ICSs that are already the furthest adrift from their financial plans to bring in management consultants to draw up lists of immediate cuts to bring spending back into line.
The nine on the chopping block are Black Country, Cheshire & Merseyside, Greater Manchester, Lancashire & South Cumbria, Mid & South Essex, Nottingham & Nottinghamshire, Shropshire, Telford & Wrekin, South East London and South Yorkshire
Taking such tough action just two months into the financial year indicates that NHSE is anticipating no leniency or financial relief after the change of government: Tory cash limits will be ruthlessly applied, no matter what the consequences for patient care.
And if the finances are already this bad for the acute hospital sector it is a grim warning of how much worse things (and especially waiting lists) could be if Streeting pursues his idea of taking money out of the acute sector to boost primary care
It seems NHSE may have had a nod and a wink that they will be permitted to resort once more to management consultants to push trust and ICB bosses into taking hard decisions, despite the public statements from new Chancellor Rachel Reeves that she wants to halve the use of management consultants in the public sector, and use them only in specific, limited circumstances.
For Greater Manchester, the top-down pressure has been even more intense, with the ICB required to sign its acceptance of ‘enforcement undertakings’ at its July meeting. The ICB has been accused of a “failure” of financial management, especially with regard to the draft financial proposals for 2024/25 and the failure to deliver £143m (31%) of the promised £606m “efficiency savings” last year.
Last year GMICB foolishly agreed to break even on revenue funding, but wound up with a deficit of £179.9m: this year the target has been set at a deficit of £175m.
Meanwhile another ICS on the hit list for management consultants is Nottingham & Nottinghamshire, which has broken from the recent trend of ICBs discussing the detail of their financial plans in secret session, and published plans to cut £61m from spending.
The biggest items on the list of cutbacks are £16.5m from a “Review of care packages (health and social care) for citizens with long-term complex health needs,” which looks suspiciously like an attempt to withdraw support for some extremely vulnerable patients; £12.8m from on prescribing, and £6.3m from “reviewing contract management”.
Some of this appears to be cracking down on the private sector, most notably the final point: “Ensure follow-up appointments in Independent Sector are clinically appropriate and in line with peers.”
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