11 January 2017

Today’s reports of a rift between No.10 and the head of NHS England show that the Prime Minister’s strategy on the NHS is to tough it out, pushing responsibility for dealing with mounting pressures onto the shoulders of the people delivering services, argues Nehal Davison.

According to today’s The Times front page, No.10 is frustrated with the Chief Executive of NHS England, Simon Stevens, for ‘being insufficiently enthusiastic and responsive’. Theresa May is reportedly irritated by Stevens’ calls for more NHS funding, claiming that the Government has already increased funding by £10 billion per year by 2020-21. The Health Committee disputes this, putting the figure at £3.5 billion.

Stevens has repeatedly told MPs that more funding is required to put the NHS on a firmer financial footing (as he argued again in today’s Public Accounts Committee hearing).

However, Theresa May has made it clear that the Government won’t be handing over cash any time soon and that a ‘long-term, sustainable solution’ is instead needed.

It is encouraging that government is not simply reaching for a sticking plaster, as it did in adult social care and prisons. No one would dispute the fact that it will take more than cash bailouts to turn around this situation, given the depth of the problems the NHS now faces. 

But we still don’t know what this long-term solution is. Instead, No.10 is resorting to finger-pointing to avoid responsibility for working out how to square the NHS circle. 

Recent headlines of hospitals declaring ‘black alerts’ and patients dying on trolleys is a stark reminder of the acute pressures in the NHS, but won’t be surprising to government.

Spending on the NHS has increased over the last six years, but activity has grown even faster. There were more than 4 million A&E admissions at major emergency departments in hospitals in 2015/16, compared to around 3.4 million in 2009/10 (an increase of 20%) and patients are waiting longer than ever to get treated.

Rising activity, combined with reduced tariff payments to providers, is placing hospitals under severe financial strain. In 2015/16, acute providers overspent by around £2.6 billion (compared to £421 million in 2013/14) and nearly nine out of ten ended the year in deficit.

The warning signs have been there for some time, but the Government hasn’t acted. The NHS Sustainability and Transformation Plans (STPs) – five-year plans to transform the way care is provided and delivered locally – are nowhere near the concrete organisational (and political) plans needed to prevent recurring deficits and further service deterioration. One option is for government to build cross-party consensus for how it intends to maintain the quality of critical NHS services within a tight spending envelope.

Instead, the Prime Minister appears to be keeping responsibility for dealing with the pressures facing services firmly on the shoulders of the people who deliver them. The risk is that she will eventually be backed into a corner, effectively waiting for a public outcry before taking action (as last year’s emergency funding for prisons and social care demonstrate). But this risks giving the impression that the Government is being bounced from crisis to crisis, without the ability to get a grip on the situation.

This isn’t just about the NHS – this is a repeating pattern across the public sector.

Further information

Next month, we will launch our new Performance Tracker – a data-driven assessment of the Government’s performance across a range of public services. The first edition focuses on five key services: hospitals, adult social care, schools, prisons and police. The first independent analysis of its kind, it will outline what the Government must do to stop bouncing from crisis to crisis and ‘grip’ the challenges facing public services.

Comments

Well said. This Government is all too quick to blame anyone else in sight for things that go wrong across the public service spectrum. We seem to be in an era of government by platitude, coupled with a significant failure on the Government's part to will the means to deliver the outcomes they claim to be seeking.

As long as NHS senior managers try to impose their views on local populations, the resistance from local partners in public and voluntary services will thwart cost savings. Effectiveness and further efficiency can only come from reforming and integrating the network of social care providers. Some CCGs are doing this but the new Devon CCG is antagonising everyone through 'command and control' approaches by their leaders. The sheer waste on money (7.4 million) on consultancy reports, which they refuse to share with the public, shows they just do not care to co-operate with anyone.

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