News / New government must focus on immediate NHS challenges

Speaking two weeks ahead of the 7 May general election, HFMA policy and technical director Paul Briddock said the service’s current difficulties could not be ignored.

Analysis by the King’s Fund at the end of April suggested NHS providers in England had overspent budgets in 2014/15 by more than £800m. And two-thirds of hospitals are concerned about breaking
even in 2015/16, said its regular quarterly monitoring survey.

In April, former NHS England chief executive Sir David Nicholson also highlighted the service’s ‘substantial financial problem’ in an interview with the BBC.  While the focus in the election campaign had been on providing the £8bn suggested as necessary by NHS England by the end of the next parliament, additional funding had to be ‘front-loaded’. And Sir David said that the NHS needed a ‘stable financial base’ to take forward the necessary changes.

Mr Briddock said the financial problems were ‘not new news’. ‘It’s something managers, and indeed everyone in the health service, have been working hard to tackle for some time. HFMA research shows nearly two in five of NHS organisations are reporting a rapid deterioration in finances. Over a third of commissioner and three-quarters of trust finance directors predicted they would end 2014/15 in a worse financial position than 2013/14.’

But Mr Briddock agreed that the immediate financial challenges facing the NHS needed to be addressed. ‘There is a consensus that we need radically different models of care and integration to ensure we stay focused on quality while meeting the demands of an ageing population, high technology costs and changing disease patterns,’ he said. ‘But many of these changes will take time to deliver, requiring political support and public consultation.

‘Meanwhile, increasing numbers of providers are falling into deficit. We need to remember these organisations not only need to return to breakeven, but also need to start to generate surpluses again –so they have the funds to invest in modern, appropriate estates that will deliver sustainable services into the future.’

Mr Briddock said there was a danger that new funding tended to come with new spending promises. The initial focus should be on deficits incurred against current spending requirements or on transformation to deliver better value, measured in better outcomes and cost reduction.

He acknowledged that some of the parties’ manifestos included pledges to provide extra services. The Conservatives have committed to seven-day services; Labour to guaranteed GP appointments within
48 hours and one week turnarounds on cancer tests; the Liberal Democrats to extra funds for mental health. And there have been commitments to fund extra staff.

‘Some of these commitments will be part of the transformation we need to see over time. Seven-day services (if backed by seven-day social care) could lead to shorter length of stay, as well as improve patient outcomes; more accessible primary care could reduce demand on acute emergency departments,’ Mr Briddock said. ‘But we also need to understand the immediate problems facing providers and commissioners, and allow flexibility for commissioners and providers to use resources in the best way to meet the needs of their local populations.’

Health hustings

The parties clashed on the future of the NHS in England at a health debate organised by the British Medical Association, King’s Fund, Nuffield Trust, Health Foundation, NHS Confederation and National Voices. For the Liberal Democrats Norman Lamb (second right) called on all parties and stakeholders to join a post-election non-partisan commission to come up with a new settlement for the NHS and social care. Health secretary Jeremy Hunt (left) said the NHS had dealt with a difficult period following the Mid Staffordshire revelations. The Conservatives had promised to back the NHS financially through ‘prosperity with a purpose’. UKIP deputy health spokesperson Julia Reid (right) said her party was committed to the NHS being free at the point of delivery, but it believed in a national, not international, health service. Labour health secretary Andy Burnham (second left) wanted more out-of-hospital care. ‘For the want of spending a few pounds in people’s homes, we’re spending thousands keeping them in hospital,’ he said.