Comment / Ale and hearty?

And those PCTs and trusts that had been reorganised and scored an overall 2 did well to achieve that level in such a short time.

I am certain that 2007/08 will turn out to be even better. We have recently issued the final set of key lines of enquiry (KLOEs). There are very few changes from 2006/07, so everybody should be confident that the improvements in financial management that they have been putting in place will be recognised. And the new set enables trusts that are recovering satisfactorily after a history of deficits to reach a score of 2, even if they do not meet their statutory break even duty.

I wouldn’t claim that ALE has been the cause of this improvement. That is down to each NHS trust and PCT and the people who work in them. But I do think it has helped, by setting out clearly what good financial management means in practice and giving boards and staff a ruler against which to measure themselves. Indeed, foundation trusts might like to try it out and see how they fare when compared with some of their NHS trust colleagues.

So it is set to continue. But after three years, it needs some updating, particularly for PCTs. This isn’t to keep everybody on their toes, although any assessment system suffers from the law of diminishing returns as people learn and play the rules. No, we really need to refresh it to recognise the demands that the NHS is facing, the new imperatives that have emerged and also to address the criticism that there is too much about process and not enough about delivery of services to people.

These points aren’t unique to the NHS. All public-sector organisations are facing lower growth in funding and a need to work more in partnership to achieve common goals for their communities, whether in health and well-being or community cohesion. The new set of 198 indicators for local bodies makes this very plain. Local authorities will now be looking enviously at the comprehensive spending review settlement for health, and I expect that quite a number of PCTs will be worrying about whether investment in social services will be enough for key access and other targets to be met. And who now thinks that efficiency shouldn’t include the idea of sustainability – pumping out carbon dioxide may be cheap in the short term, but is it really good value for money over time?

So, we are taking a fresh look at ALE, particularly for PCTs. The core essentials will remain, but it needs to recognise wider developments and the way in which commissioning and local services are moving. And, who knows, we might even go in for a spot of rebranding – something catchy but solid, timeless but forward-looking. I know, what about ‘use of resources’?

Andy McKeon is managing director for health at the Audit Commission