What’s Going To Give In Balancing The Books In The NHS?

Election time brings the usual pledges and promises.  All parties now seem to be saying that they will provide the £8bn funding gap identified by NHS England.

All good you might think.  Well maybe.  Of course any funding coming into the NHS is welcome.

Yet in a recent article on NHS Managers from Roy Lilley, he pointed out that the £8bn gap assumed that 2-3% of efficiency gains would be made each year.

The 5 Year Forward View shows the position under different scenarios.

The £8bn gap is the best case scenario.

The question I have as someone who use to be an FD in the NHS is:


What’s Going To Give In Balancing the Books?

Pay costs for the permanent staff are the single biggest element of expenditure.  The bulk of these staff are involved in delivering front line services.  Clearly there is always work you can do to reduce high cost temporary staff spend but as we know there is no quick fix.

Medical and surgical supplies is the next big area of expenditure.  While there will always be opportunities to improve procurement and standardise this will only take you so far.

For leadership teams, both clinical and non clinical there is a real challenge.

Cut staffing, particularly front line staffing and you increase risk.  I’m pretty certain no one wants a repeat of Mid Staffs.

If you go ahead with cutting frontline staff, you have to be looking at capacity and taking out some of your capacity.

Given you have little or no control over emergency activity, what this means is you have to look to your planned capacity.  In other words, longer waits for outpatient, day case or inpatient activity.  How will this sit with the public and the local MP who has promised there is enough money?

Of course you can always cut and improve back office costs.  Again this helps.  However, let’s not pretend that everything that is getting done which cannot be automated will still get done.

It’s a real challenge and for me one that needs good open debate within health economies and with those that use services.

Duncan Brodie helps health and other professionals to become even better leaders.  Learn more here