Everyone an=t the coal face knows the truth. It’s worse than the public know. Finances, people and standards are all threatened. Gagging is endemic. There are no exit interviews and the language of health is dishonest. More patients will die. Ii’s much worse than 14 months ago, and Its going to get worse…
Files show Department of Health has embarked on a national programme to change current accountancy practices
NHS trusts are being placed under pressure from Government to change the way they report on their finances, in what critics described as a desperate attempt to reduce a looming health service deficit.
The health service is currently forecasting a deficit of £3bn by the end of this month – the highest in the history of the NHS – amid widespread failures by NHS trusts to cut their spending.
But documents seen by The Daily Telegraph disclose that the Department of Health has embarked on a national programme to change current accountancy practices, and to encourage trusts to be more optimistic about their financial problems.
The review being carried out by four major accountancy firms aims to explore “areas of opportunity” about ways which NHS finances could bereported differently.
In a series of euphemisms, briefing documents suggest that trusts will be asked whether they are being “overly prudent” in forecasting how much income they might receive from outside the NHS, or how much they likely to end up spending on agency doctors and nurses.
It details 19 specific accounting areas to explore, such as reclassifying assets so they are kept off the balance sheets, or extending their asset lives so they can be valued more highly.
Sally Gainsbury, senior policy analyst at thinktank the Nuffield Trust, said: “This definitely falls into the area of fiddles – being clever about when you book income and when you book expenditure. It pushes most of the problems into the next financial year, it does not solve them.”
“No one is thinking about the long term position. It is misleading the public about what the NHS’s costs really are. ”
A senior figure in NHS consultancy told Health Service Journal the work was “an act of desperation” by the DH, adding: “Directors of finance are getting loads of pressure from the centre to do accountancy stuff they are not comfortable with. [They are] getting their arms twisted.”
On current trends, the NHS deficit is set to reach more than £2.8bn by the end of the current financial year, largely fuelled by spending on agency doctors and nurses.
The figures raise the prospect that the Department of Health could be forced to get a bailout from the Treasury, a serious breach of Whitehall protocol and would be likely to trigger an inquiry by the Public Accounts Committee.
Health officials have repeatedly pledged to clamp down on spending on temporary health workers.
But figures published last month show hospitals have spent £2.72bn on agency and contract staff – £1bn more than was intended.
Meanwhile a Telegraph investigation revealed that more than 20,000 NHS shifts a week are being filled by doctors and nurses on rates which breach the new limits set in order to clamp down on spending.
The figures from NHS regulators show that the deficit for the first three quarters of the year is already £2.26bn – triple what it was for the whole of the previous year.
The situation raises the prospect of the Department of Health failing to balance the overall books, which would be politically difficult, given the extra sums being spent on the NHS.
In autumn’s spending review the government announced the NHS would get an extra £8.4bn this Parliament.
After pleas from the head of the NHS, the funding is being “front-loaded” with £3.8bn being put in next year. But the rapidly deteriorating finances mean trusts are likely to use much of the new money just to keep afloat.
Last weekend, former Liberal Democrat cabinet minister David Laws claimed Downing Street had “leant on” the chief executive of the NHS to reduce the amount of money he said was needed by the health service.
Mr Laws said Simon Stevens, head of the NHS, had told Downing Street that the NHS needed to find £30 billion, and that £15 billion could be found through efficiency savings.
But Mr Stevens was then told there was “no way” David Cameron and George Osborne would sign up to providing the other £15 billion, Mr Laws said.
“He did that, reduced therefore the demand to £8 billion,” said Mr Laws, who said more had been needed.
A spokeswoman for NHS England denied that Mr Stevens had been “leant on”.
She said a 5-year-plan for the NHS produced by the chief executive in 2014 “clearly and independently said that the NHS would need in the range of £8-21bn real terms annual growth by 2020, depending on levels of efficiency, capital investment and transformational funding.”
A Department of Health spokesperson said:”Patients will expect that the NHS is making sure every penny is accounted for as accurately as possible so we have commissioned some additional assurances on both potential savings and any unaccounted for overspends from an initial sample of 20 organisations to ensure figures are reported as accurately as possible.”