Two written answers from the Department of Health and Social Care

I am continuing my questions to the Health department to highlight the  lack of specific costed plans to deal with the waiting lists and quality of service issues that worry people. I am urging the Treasury to make the grant of extra cash conditional on clear plans to deliver more and better service, which in turn will need suitable workforce plans. The answers below confirm there is plenty of management work to be done to set out what additional better service they are promising and how they will spend the extra money they have been granted.

The Department of Health and Social Care has provided the following answer to your written parliamentary question (146529):

To ask the Secretary of State for Health and Social Care, in the absence of a manpower and recruitment plan, what steps the NHS takes to forecast its spending needs for the year ahead. (146529)

Tabled on: 24 March 2022

Edward Argar:

NHS England and NHS Improvement published the ‘2022/23 priorities and operational planning guidance’ on 24 December 2021. This is supplemented by technical guidance on the associated financial assumptions on which the National Health Service should plan. Individual systems plan spending for the year against allocations in response to this guidance and submit plans to NHS England and NHS Improvement to aggregate into an overall NHS financial plan. We expect the NHS to manage their spend within the overall budget in the Mandate.

The answer was submitted on 29 Mar 2022 at 13:13.


The Department of Health and Social Care has provided the following answer to your written parliamentary question (146531):

To ask the Secretary of State for Health and Social Care, how often he meets the Chief Executive of NHS England to review progress with reducing waiting lists and other matters. (146531)

Tabled on: 24 March 2022

Edward Argar:

My Rt hon. Friend the Secretary of State for Health and Social Care meets regularly with the Chief Executive of NHS England to discuss a range of issues, including progress on reducing waiting lists.

The answer was submitted on 29 Mar 2022 at 13:15.


  1. David Peddy
    March 31, 2022

    Tells you everything that you need to know about the management of the health service.
    Flying by the seat of their pants with uncalculated provision and unmeasured outcomes
    Non answers as usual

    1. Peter
      March 31, 2022

      The evasiveness is because they don’t know precisely and/or they resent the intrusion into their day to day activities.

      A general picture is emerging.

      However, unless there is a growing call to remedy these numerous failings the revelations will have no further impact. There may be a defensive counter attack that it is not for outsiders to micromanage their activities. How do we escalate our concerns ?

    2. Ian Wragg
      March 31, 2022

      That way they can always plead poverty. The government didn’t give us enough money without actually having a budget outlining what they actually need.
      As I’ve said many times, if the NHS had the whole economic output and everyone worked for them they would still not have enough resources (money).

  2. DOM
    March 31, 2022

    The now political NHS will always act in the best interests of the NHS which may explain why the patient and indeed the taxpayer are treated with total contempt, almost an inconvenience to be avoided at all costs

    John does his best regarding this Socialist organisation but he knows that his party is now wedded to defending this Labour aligned organisation at every turn for fear of being labelled ‘anti-NHS’. This politics of capture of the Tory party can now be seen across many issues of the day

    A captured Tory party fearful of its own shadow is a threat to this nation, our freedoms and our liberties for it means that the Tory party itself will sacrifice all that they feel is necessary to protect the party from all organised political power.

    Labour and the SNP are an existential threat but a captured Tory party is even greater unpredictable beast

    We so desperately need decent Tory MPs to expose their own party leaders before they sell our freedoms and liberties down the woke river to protect themselves and their careers

    1. Nottingham Lad Himself
      March 31, 2022

      I actually agree with your observations as to the relationship between NHS and patient.

      However, I don’t think that this has anything whatsoever to do with socialism, and you might care to check the CVs of its senior people.

      It’s a feature of large organisations, near-monopolies, and the deliberate blurring of accountability, which happens in most areas of UK life these days.

      The Tories have been in power for twelve years now, incidentally.

      1. Mickey Taking
        March 31, 2022

        I agree Martin – the NHS monolith has become an empire, employing the biggest group of workers, multicultural, diverse, multifaceted, consisting of multiple divisions, organisations, contractors, researchers, budget holders, political objectives etc.
        The only way out is to break it up into discreet healthcare provisions, unique structure, staffing and budget with objectives set by a Government department not remotely connected to the NHS.

  3. Mark B
    March 31, 2022

    Good morning.

    . . . meets regularly . . .

    What, once a week, month, year ? That is a non-answer.

    The problem with the NHS Budget and spend is that it is based on the bureaucratic model rather than a business model. It is based on, ”We need a fixed sum to spend.” and when that fixed sum is exceeded, as it always is, then there is a demand for more. Unlike a private business model which knows all fixed costs, (energy, rates, taxes etc) and has an idea on variable costs, (materials, labour, investment etc) and knows that if it is to meet those costs it will have a range of options. ie Sell more, cut spending, borrow and, if a PLC, raise money through shares.

    The NHS has an open door policy where basically anyone whether they pay in or not can access its services and place demand upon it. There is simply no mechanism whereby demand and money supply can balance. Demand will always outstrip supply because the NHS cannot charge / raise fees to balance load / demand. ie If more people access the service more money would be generated and therefore more investment (eg Staff) would be made to meet demand, with the reverse being true. ie Less demand, fewer staff.

    To that end the NHS, along with both Sacred Cow status and over protection from the unions can never be reformed and so, we are destined to throw evermore money at what is, a self-perpetuating problem.

    1. alan jutson
      March 31, 2022

      Mark B


      I also fear your last paragraph is correct.
      Recent breaking news over the near 20 year cover up fiasco at Shrewsbury & Telford, with many other failures before it, should be a huge warning to those who think the NHS is a World class service.
      Another apology, another claim that lessons will be learn’t, another claim that they do not get enough funding, etc etc.

    2. a-tracy
      March 31, 2022

      MarkB I thought the same thing, maybe a more direct open question, how many times will you meet in the next six months and at what frequency?

      The NHS doesn’t have to sell their service, they get paid whether they provide the service or not, nor are they concerned about the quality of service – just how did 200 excess baby deaths not trigger after five excess deaths? How on earth did this go on for so long?

      The NHS doesn’t have to treat people without an NHS number, does it? I thought they had to pay with medical insurance or pay for their own treatment? They should patch up and move them like the rest of the EU do. My mother was told pay on your credit card whilst her insurance company was trying to sort out the payment in Spain. With European Health Cards the NHS could bill back the other nations as they do us and offset the costs, its ridiculous that they dont.

      1. Mark B
        April 1, 2022


        And that is part of the reform I believe in. I have said here that a condition of visa to enter the UK would be that they have medical insurance with a UK based company. That way we would not be scammed. So simple.

  4. Lifelogic
    March 31, 2022

    Another non answer. We already know that the new CEO of NHS England is innumerate and inept. Back in Nov 2021 she said that the NHS was “running hot” with “very real pressures on health and social care”. She added: “We have had 14 times the number of people with Covid in hospital than we saw this time last year.” this when actually they had rather fewer people with Covid. So not exactly on top of things.

    After a degree in Modern History she has worked for the dysfunctional NHS all her life. The appalling Shrewsbury & Telford Hospital NHS Trust maternity problems are in my experience all that that untypical of the NHS performance in general.

  5. Bob Dixon
    March 31, 2022

    So we have a 20 Year problem with 1 NHS Trust over maternity provision. The investigation took 5 years.
    Has the current health secretary plans include looking into other areas of The NHS?

    1. Lifelogic
      March 31, 2022


  6. Sea_Warrior
    March 31, 2022

    Answer 1 appears to have been written by Sir Humphrey. Answer 2 was evasive.
    Keep at ’em, Sir John.

  7. BOF
    March 31, 2022

    Two concise questions. Two vague answers.

    The NHS will never get spending under control!

    1. Ian Wragg
      March 31, 2022

      The NHS doesn’t want to get spending under control. We would be able to monitor the waste then.

      1. Mark B
        April 1, 2022


    2. Nottingham Lad Himself
      March 31, 2022

      Let’s bear in mind that a careful 2021 study calculated the cost of fraud alone in the UK to be £137 billion a year.

      Then there’s the rest of crime.

      All in all it’s about twice the average pro-rata rate for countries of the European Union.

      So yes, the NHS needs to be far better at treating patients, but if its money that bothers you then there are perhaps larger and easier savings to be made elsewhere.

  8. clough
    March 31, 2022

    So the NHS comes up with ‘guidance’ on how to plan, not actual plans. ‘Individual systems’ (whatever they are) make plans, but the NHS itself doesn’t. That seems to be the nearest thing to substance, Sir John, in the evasive reply you received from this Edward Argar person. Do you happen to know if other state-run bodies work like that, e.g. the police or the military? For example, if the Army doesn’t itself make plans, but the Royal Engineers do?

    1. Nottingham Lad Himself
      March 31, 2022

      The Executive of the State is the Government.

      It’s been Tory for the last twelve years.

  9. Donna
    March 31, 2022

    Define “regularly.”

    If that was put in a legal document it would mean diddly-squat. And that’s exactly what it means in this evasive non-answer.

    It’s blindingly obvious that NHS spending is completely out of control and the Government has no means (or, it appears, intention) to try and control it. They just shovel money into it and hope for the best.

  10. Narrow Shoulders
    March 31, 2022

    As I wrote yesterday – the NHS is paid for being not for doing.

    It should move to invoicing the state for work done not for merely existing.

  11. ChrisS
    March 31, 2022

    There will be no progress towards proper management and accountability for the NHS until it is taken right out of the political arena. As long as Labour can make political capital out of the “under resourced” NHS, no Conservative Government can get to grips with it.

    I recently suggested that one way to resolve this difficulty would be for the NHS in England and Wales to have its objectives and annual targets set by a grand committee of the House consisting of all English and Welsh MPs. All the Ministerial team would have to do in advance would be to propose a realistic budget, agreed with the Treasury. MPs would have to be equally realistic in setting the objectives and targets year by year and NHS Management would then have to accept the budget and meet those targets or face dismissal. In the event of a disagreement over the budget, the grand committee would have to instigate its own discussions with Treasury Ministers.

  12. Hat man
    March 31, 2022

    SJR, perhaps the NHS is unable to forecast manpower and recruitment needs because its newly created ‘Transformation Directorate’ is still working on how far face-to-face contact with patients can be reduced further? ‘The strategy for technology in health and care is to digitise services’, its website says
    This suggests to me staffing needs will tend towards recruiting IT people, rather than doctors and nurses. Maybe you aren’t getting clear answers because the Transformation Directorate needs more time to decide how far the public can be pushed into accepting a ‘transformed’ NHS.

    1. BOF
      March 31, 2022

      +1 Hat Man. How long will it take to find out that computors and tele coms don’t diagnose illnesses, nor do they wipe bottoms!

  13. John McDonald
    March 31, 2022

    A question- what is the ratio of Managers/administrators to Doctors/Nurses/direct clinical support staff in labs/technicians /cleaners/cooks etc. ?
    If you can’t get the workers get more mangers to maximize the efforts of the few workers you have. -Modern Management theory. Also cut costs and get yourself a performance bonus for doing so.

  14. X-Tory
    March 31, 2022

    I just want to point out that in the first answer, the reply “Individual systems plan spending for the year against allocations” just means that the NHS plans what to do with the money that they are given, NOT that they “forecast its spending needs for the year ahead” as Sir John asked. In fact, they do things completely the other way round – first they get all the money they can, then they decide what to do with it! This is the most ‘arse about tit’ way of operating that you can imagine.

    As for the second reply, well, it WASN’T a reply at all, was it? “Regularly” means nothing. Once every 10 years is ‘regularly’! So once again Sir John clinically exposes the uselessness of the NHS’s management, and yet allows Sajid Javid, the most ineffectual minister in government, to continue with this shambles without puclicly denouncing him.

  15. Martin
    March 31, 2022

    What will the extra cash thrown at the NHS buy? I doubt there are dozens of Drs .and Nurses on the books at the local dole office.

  16. Kenneth
    March 31, 2022

    What happened in Shrewsbury was digusting. Taking years to report on it is also disgusting.

    I know from personal experience that going into a hospital is dangerous these days.

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