Wisdom from Andy Burnham

Civitas, 17 September 2009

Surely Andy Burnham made a bit of a howler today in a speech to the King’s Fund.  NHS mangers, he said, must not conduct their own ‘mini spending reviews’ in advance of political decisions about NHS funding.  But surely this is what any responsible manager would be doing?

Haven’t we already heard just this from David Nicholson, the NHS chief exec, who has openly said that the NHS will have to make efficiency savings (due to cuts in funding) of £15bn-£20bn from 2011-14.  Presumably he wouldn’t have said this without political backing.  And here’s what he had to say at the NHS Confed conference: “If we don’t think about [cuts] again until Christmas and we just carry on we will get to the end of 2010-11, suddenly the money will dry up and we will have to rush around trying to solve the problem”.

Too right.  There’s something called risk assessment and financial planning that any prudent organisation would carry out.

For an example of why this is needed, go and look at any of the strategic plans that PCTs produced for the opening round of the world class commissioning assurance regime in 2008.  Very few of them mention anything about a financial crisis and the impact this is likely to have on the NHS.  Instead, most plan for an environment in which there will be a yearly increase of around 4% from 2010/11.  This is clearly not going to happen, whoever is in power.  Being part of five-year strategic plans with investment decisions tied to them, you’d be pretty worried if they hadn’t starting looking at what might not be possible, or where savings could be made.

And, on this line, another bone to pick with Mr Burnham.  Why should the NHS be the ‘preferred provider’ of community services?  When it comes to competitive tendering, all providers should be on a level-footing; let the best (the best, not the cheapest or the ‘preferred’ provider) win.  It may very well be the NHS provider, but surely we should be concerned with who can provide the best services to patients, rather than ideological attachment?