The damning statements from the finance officers show how neglect and denial have built up to a point where it will take 15 years, and the importing of many overseas nurses and doctors to even start to put our 4 health services right. Since devolution has failed in Wales it will be even harder here, where I am based. “…..Incremental neglect tips over into significant and costly malfunction, and opportunities for strategic renewal and improvement are being squandered. Many interviewees identified ways that their trusts could better manage their capital investment programme, but these were eclipsed by the near-universal call for increased funding and a relaxation of central controls.
Iestin Williams reports for the Health Foundation 8th March 2019: Views of NHS finance officers on limited capital. see below…
Laura Donelly on 28th May 2019 in the Telegraph reports: A doubling in rationing of cataract surgery
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3190 (Published 04 July 2017) Cite this as: BMJ 2017;358:j3190
Laura Donelly in the Telegraph 11th August 2018: Numbers “going private” for surgery soaring as NHS rationing deepens.
Nick Triggle for BBC News 4th July 2017: NHS ‘rationing leaves patients in pain’
Pressure on NHS finances drives new wave of postcode rationing https://doi.org/10.1136/bmj.j3190
(Published 04 July 2017) BMJ 2017;358:j3190
[PDF] NHS Rationing and the Law. Warwick Heale. MA Medical Ethics. Interest in legal and ethical issues in treatment funding decisions.
Iestin Williams reports for the Health Foundation 8th March 2019: Views of NHS finance officers on limited capital.
Fixing leaky roofs, servicing ageing scanners and updating antique IT systems – the maintenance of capital infrastructure in the NHS isn’t the most enthralling of topics, and it’s generally only talked about when things start to go wrong. However, recent warnings about the lack of NHS capital investment and controls on capital spending by trusts have put this issue very much in the spotlight.
At a national level, we know that for some time now, money has been diverted towards the day-to-day costs of health care and away from capital budgets, leaving them severely squeezed. However, less is known about what this means for the trusts affected and the services they provide. We tried to find out more by speaking to finance directors at NHS trusts across England.
Squeezed to breaking point?
The trusts involved in our study were clearly feeling the financial pinch. In itself, this is nothing new. For example, taking out loans to pay for new IT systems or delaying the overhaul of outdated estates are commonplace. However, when basic maintenance work starts to be repeatedly postponed, the concerns voiced become a little more insistent. This was the tone of many of our interviews. We were struck by the prominence of the word ‘crisis’ – one not used lightly by seasoned finance personnel.
The squeeze on budgets has necessitated tough decisions about what to fund and what not to fund, and in what order. As a result, all but the most urgent of capital plans were frequently being abandoned or at least put on hold. In many cases, considerations around efficiency and improvement have been crowded out by more immediate concerns over safety and service viability. However, while this has mitigated the short-term impacts on patients and services, finance directors frequently lamented the potential long-term harm. In short, organisations were engaged in reactive rationing, rather than proactive priority setting.
Navigating the system
Interviewees described a much-changed environment in which sources of funding they had previously used for major capital projects were increasingly unavailable. Many trusts have found themselves unable to generate revenues to pay for capital projects, and were frustrated by the central financial controls imposed upon them. Others argued that the process for applying for centrally held NHS funds, including through partnerships arrangements such as STPs, was increasingly complex and inaccessible. Opportunism – for example, in the form of asset sales and charitable fund raising – offered only a partial solution to those trusts with access to these options.
All these factors are building towards something of a ‘perfect storm’, in which incremental neglect tips over into significant and costly malfunction, and opportunities for strategic renewal and improvement are being squandered. Many interviewees identified ways that their trusts could better manage their capital investment programme, but these were eclipsed by the near-universal call for increased funding and a relaxation of central controls.
Dr Iestyn Williams (@IestynPWilliams) is a Reader in Health Policy and Management and Director of Research at the Health Services Management Centre at the University of Birmingham