Order Of The Day: All Defeatists And Cowards Will Be Shot

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Anyone who has read Anthony Beevor's excellent Stalingrad will know how today's NHS works. There must be no surrender! There will be no surrender! Panic mongers, defeatists, and cowards will be shot!

No surprise then at Order Of The Day No. 427, issued by Field Marshal Comrade Sir Nigel Crisp, acting under special authority from CPO Commissar Hewitt herself. In a last-ditch death or glory bid to control those ballooning NHS deficits (see here and here), he has told heads of 28 strategic health authorities that he holds them personally responsible for halting all discretionary NHS spending. The Order calls for "drastic action by noon on Monday", and reads:

"The position has further deteriorated and Sir Nigel requires immediate action by each and every NHS organisation to redress this. There can be no exceptions. We need you to secure from every PCT and NHS trust a plan to materially improve the position for month 11 and 12 [February and March], signed off by the organisation's chief executive."

The memo, signed by Duncan Selby, director of programmes and performance, called on all trusts expecting a financial balance to achieve a surplus to help make good the deficits in other parts of the service. He called for "a forensic, immediate grip on avoiding all discretionary spend by everyone".

What counts as "discretionary spending" is of course a moot point. We know the Hospital Trust covering the Commissar's own constituency thought that paying council rates might be discretionary- that is, until the bailiffs smashed down their front-door to put them right (we presume the Chief Exec of that trust is now reflecting on his position in the Lubyanka). Other trusts are almost certainly considering the postponement of wage payments, particularly since at least one has already been forced to run up credit card debt to cover them.

But with the prospect of getting shot to concentrate the mind, it's patient care that is the most discretionary expendable item. Which is why all over the country, heart ops and other such fripperies are being canned. Don't on any account get sick before 6 April.

So how big are these deficits? 'A department spokesman refused to disclose the scale of the deficit forecast by trusts at the end of January. NHS sources suggested, however, that overspending had increased since Patricia Hewitt, the health secretary, told MPs in December that the service was heading for a net deficit of £623m in 2004-05.' Most independent estimates reckon it's a billion or more. Both figures are way over the £200m Sir Nigel last year said would be "acceptable".

We've blogged before about how on earth it can be possible for all those extra NHS billions to produce a scary life-threatening shambles like this. Quite simply it reflects the grotesque failure of top-down central planning, and responsibility lies with the those at the top. Labour and the NHS bureaucrats have talked the language of devolved authority, choice and markets, but as always, they've failed to enact the means.

In many repects their "planned markets" approach has produced the worst of both worlds. For example, as the FT reports today, "the Department of Health has had to withdraw a price list that was to be used from April to pay hospitals for the treatments they undertake" because they have found "underlying errors". That's very serious indeed, since the tariff is the cornerstone of the NHS healthcare market- if say, the the prices hospitals get paid to carry out heart ops are too low, well, guess what, they won't be able to afford to do them. Which is exactly what happened at the John Radcliffe, and doubtless many other hospitals (as always, see the excellent Doc Crippen for more such lunacies).

After the German army had reached the suburbs of Moscow, Stalin eventually realised he had to devolve more authority to his field commanders. Sadly, we're still some way from that with the NHS.