The ever-excellent Reform has published its annual report on the NHS: NHS reform: the empire strikes back. It's well worth reading.
The overall thrust of their argument is familiar: despite all the rhetoric, the NHS remains a top-down Stalinist system with a few cursory "choice" bolt-ons. And now the money's running out, the Stalinists are re-tightening their grip. The NHS is all set to cut our health rations, only from a much higher cost base.
Some interesting specifics:
Deficits As we know, the Commissar has staked her career on getting the system back into financial balance by year-end. So whatever the consequences, we can be absolutely totally 100% sure that will definitely take place. Without fail.
And predictably enough, it's being achieved through a "forced march" style programme of "top-slicing" by Strategic Health Authorities, so that all trusts feel the pain, whether or not they are in deficit. Moreover, as a belt and braces, the DoH is establishing a new £450m contingency fund to bail out deficit trusts.
It's a giant dollop of financial fudge, but as Reform points out, beneath the fudge, the number of trusts now in deficit has actually increased since this time last year (175 compared to 133).
And as always with fudge, it's quickly getting impossible to work out quite what's going on, let alone have any hope of sorting out the real management issues.
Future Resource Gap As Reform has highlighted before, the DoH publishes no long-term cost projections. Indeed all the evidence is that they have no long-term cost projections. The report says:
"The absence of an underpinning process is a critical policy weakness. The key absence is the lack of financial planning and costed measures in the key policy statements. This absence was particularly noticeable in the key White Paper Our health, our care, our say. But the same criticism can be levelled at the recent intervention by the Prime Minister and the short papers by the National Director for Heart Disease and Stroke and the National Director for Emergency Access.
Neither paper contains a single costed measure to bring about change. Furthermore, neither paper proposes any changes to staffing or capital which would support changes in service. For example, the creation of specialist cardiac centres would depend on the creation of a cadre of specialist professionals who do not currently exist."
Just let that sink in. Here we have the largest organisation in Western Europe, and it's run by a bunch of clowns who are so arrogant and/or stupid they don't consider it necessary to connect up their wild promises with the practicalities of delivery. Or more likely, they haven't a clue how to do it.
What that means of course, is that there is only the vaguest relationship between what the commissars promise, and the resources they provide to deliver it.
Reform call the difference the Resource Gap, and they reckon it will reach crisis proportions over the next three years. That's because whereas the NHS budget is set to grow by only £8.3bn, their costing of commitments already made, comes in at £16.5bn- a Resource Gap of £8.2bn, or around 10% of the budget, which is huge. Here's their projection of the increased costs (all figures are in 2006-07 prices):
Medical unemployment We've blogged before about the nonsensical situation of expensively trained doctors and nurses now being unable to find NHS posts, and Reform pulls together some jaw-dropping DoH projections showing how much worse the situation is likely to get. It turns out that the number of new graduates is about four times the number of retirees. And we've paid (£250 grand each in the case of doctors):
Waiting Lists We all know how the commissars like to boast about how they've reduced waiting times. But what they neversay is that while maximum waiting times have come down, average/median waiting times have gone up. Reform provides this useful summary for future reference:
Gershon Despite the hoots of derision, Gordo and the Commissar still keep telling us that those Gershon efficiency savings will provide the cash the NHS needs. We know what we think, but just for completeness, Reform says:
"We repeat our belief that many of the supposed efficiency gains are vague and hypothetical and therefore unlikely to be achieved and make any substantial financial improvement to the service. The savings – particularly in procurement – cannot be expected to continue... Of the current savings only £2.3 billion – 62 per cent – of the savings were cashable. Efficiency gains that are not cashable are not a real saving but instead simply a reduction in workload."