Will this finally be the government which gets on top of the voracious financial monster that is the NHS and tackles its chronic over-spending? No, I can’t quite see that, either. But it has to be said that the new interim Chief Executive of NHS England – Sir Jim Mackey, who has replaced Amanda Pritchard – has made a good start. Rather than just beg the government for more money he has turned on the leaders of NHS trusts, who have been told to go back and revise the spending plans which they recently submitted.
Well he might. Even with an extra NHS England granted an extra £25.7 billion over two years in the autumn budget, it seems that NHS trusts have still found ways of over-spending. The combined spending plans of NHS trusts, it turns out, exceed the money available by £6.6 billion. Not only that: writing to NHS trusts Mackey – in a joint letter with Pritchard – warns that he has “limited confidence of delivery of operational expectations”. In other words, he is far from sure they will even manage to stick to the excessive budgets they have prepared. He goes further, saying that he is “considering a fundamental reset of the financial regime and accountability”.
The NHS has developed a culture of weak financial management thanks to successive governments failing to take on what they perceive to be sainted organisation in the minds of the UK public. We were invited to turn out to ‘clap the carers’ during the pandemic; no-one, on the other hand, seemed to think it necessary to turn out to clap farmers, supermarket workers, who kept the country supplied with food, or water engineers who kept us with fresh water. It is attitudes such as this which have led to an idea of NHS exceptionalism: namely that the NHS is stuffed full of heroic people doing vital things and that it deserves to be excluded from normal financial constraints. Our health, in that bone-headed platitude you still hear from time to time, is too important for money.
Of all government departments, only health and international aid were excused from the round of emergency cuts brought in by the coalition in 2010. Vote Leave promised it every penny of the money which would be saved once we no longer had to send £350 million a week to the EU. And while that might have been a dodgy figure – gross rather than net – Boris Johnson’s government ended up boosting the NHS budget (even outside the immediate crisis of the pandemic) by more than twice that amount every week.
During the pandemic, the brakes were taken off NHS spending in a way that was unprecedented for any government department at any time in history. Thus the NHS has never been forced to confront fiscal reality in a way other government departments have been.
The health service continues to operate on the lie that everyone can have whatever healthcare they need – and indeed would get were governments just a little less mean and austere. We never have the honest conversation that we need to have: given the unlimited wants and limited resources, where should we draw the line between what should and what should not be available on the NHS?
It is hard to see much changing under the present government, especially given its capitulation to the unions in awarding fat, unconditional pay rises for doctors. But for the moment at least, the right noises are coming from the top of NHS England.
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