Health spending up – health stories of cuts

Today’s Sunday Telegraph story of Health Authorities planning cuts to operations and services for patients makes grim reading. The story should pose this question – Why are the managers even thinking of cutting important services when they have been told spending will rise in real terms?

It’s very old politics for public service managers to trot out unacceptable “cuts” they claim they need to make to live with the increased money they have been given to spend. In the new world we need public sector managers who can improve services and deliver more when they are offered more money. Health is being offered a rightly privileged position in the current spending round. In return I look forward to it avoiding these sensational and worrying stories. The answer to any Health manager who offers such fare should be a polite “No”, and a requirement they start to manage better.


  1. Steve
    July 25, 2010

    Here's one simple answer for Mr, Lansley. Take the total value of all the front line cuts being proposed by NHS management, and then instruct them to make the same savings instead by cutting their own back office bureaucracy, including their own management positions if that is necessary. That will teach them about playing politics, as well as about how to make useful cuts in unnecessary .expenditure. If they can't or won't do it, it shouldn't be too difficult to find someone from the private sector who will do it for them.

  2. Brigham
    July 25, 2010

    What a wimpish conclusion! If the manager is talking the extra money down, give him/her their cards immediately for incompetence. This would make the others sit up and take notice, and also reduce the overmanning in the NHS.

  3. m wood
    July 25, 2010

    Perhaps someone should take a look at the political affiliations of some of the authority managers involved ……

  4. Brian Tomkinson
    July 25, 2010

    Many of these people are Labour placemen and women. They will do all in their power to frustrate and undermine the Coalition. Scare stories such as this will be commonplace before long. A wholesale clear out from government, not transfers to other departments, will be necessary to make the progress that is so essential if we are to begin to restore this country's finances.

  5. David Price
    July 25, 2010

    But these are people being paid 100K+ to administer their organisations to try and meet the needs of the public at lower costs, instead they are playing politics and trying to improve their own positions and/or maintain their empires at our expense,

    Why on earth should the public continue to employ them?

    I don't believe a polite "no" is good enough. How will you ever trust them to adopt the right attitude. You will have to continutally review what they do in ludicrous detail to ensure they are doing what they should. Their first action was to find ways to defy the intent and wishes of the government. If all you do is give a mild admonishment you have rewarded them for playing this game.

    They should be let go immediately and since the country is bankrupt there should be nothing more than statutory redundancy and notice.

  6. Alan Jutson
    July 25, 2010

    Time to call in the heads of all these NHS Trusts to Downing Street for a dressing down, and make them aware of the real facts, then have a news conference to tell us the result.

    An increase in spending can only be a cut, if inflation is rather more than the increase in Government Grant.

    My suspiciion is that after many years of money just being thrown willy nilly at the NHS, with little or no control over how it is spent. The NHS Trusts are now having to account for decisions made, in those non realistic financial times where money was no object,

    As in Private industry it should be possible to manage a Trust Properly, look after your customers/patients, and be efficient, but if you fail, you should be prepared to be replaced by someone who can.

    They are not on peanuts are they, so there will hardly be a shortage of candidates available to take their place.

  7. Norman
    July 25, 2010

    The answer to any Health manager who offers such fare should be a written warning followed by the advice that he may fancy a change of career (preferably not in the public sector).

    The public sector is completely out of control and offers us taxpayers little value for money, not only compared to the private sector but compared to other developed countries.

    We certainly are world leaders in getting less for more.

  8. David H
    July 25, 2010

    So why aren't the so called `managers' cutting the bloated bureaucracy instead of threatening front line services? Turkeys don'y usually vote for Christmas, I suppose. The Government should intervene directly and make an example of one or two of the offending Authorities if they really mean business.

  9. London Calling
    July 25, 2010

    There is no contradiction between cuts and increased expenditure. My local trust has a historic accrued deficit in excess of £100m due to its inability to live within its means for the last decade( in which as you say funding rose constantly) . Trusts have a duty to balance their books "taking one year with another", that is, to find their way back to balance, and many haven't done so. As a result, more local people have been treated or some treated more expensively than the allocated commissioner funding would allow.

    Getting into financial balance is the issue, income and expenditure, not cuts vs unaffordable levels of service delivery.

    I look forward to my local GP-led new commissioning consortium picking up the deficit, living within its means, without calling it "cuts"

  10. D. Vaughan
    July 25, 2010

    absolutely spot on.
    The self serving beaurocracy (sp?) which seems to be full of NL placemen and those working to a 'common purpose' needs to be beaten and soundly so.If not the coalition or hopefully at some point a wholly conservative Government will fail in sorting out the big structural problems we face. In the NHS they seem to be pulling the 'or else the puppy gets it' trick. I also read today about the BBC pension fund top ups for the top-brass. Appalling.

  11. English Pensioner
    July 25, 2010

    I agree with your all of what you say except for the last sentence, which should read
    "The answer to any Health manager who offers such fare should be "You're Fired".

    Just as schools have pupil / teacher ratios, the NHS should have a minimum nurse / patient ratio and a maximum administrator / patient ratio based on the best practice within Europe.

    1. London Calling
      July 26, 2010

      Many US Hospitals routinely report the Qualified Nurse to Patient ratio on their wards. This is at the heart of the safe vs unsafe care on Medical Wards. How else can anyone judge if the care is judged adequate? Not by claims of "cuts",or by thenumber of guilt-driven middle-class daughters who make a fuss about their mothers care to the media.

      Its simple. Other countries do it. Do you not employ anyone that can see that and articulate it simply? Then your problem is you continue to employ the wrong people.

      Instead we get spin about abolishing targets – old Labour targets which are greeted with hoots of derision by NHS management because they are effortlessly easy to work around. Instead of abolishing "good" targets, why don't you just enforce them and catch out the fraudsters?

      Take off the Manifesto spectacles. NHS management all read the Guardian on the way to work. They are the enemy, but not for reasons of "bureacracy" you think. In my 20 years NHS experience they are a club for the totally useless.

  12. socrates
    July 25, 2010

    Many years ago there was a story about cuts in the US. One State had a great need to cut budgets and one area to suffer was the customs department. It will come as no surprise that the day after the cuts were implemented there were no customs officers at the border but the bueaucrats were completely unscathed. Bureaucrats have no interest in the aims of their department merely the survival of their own empires. Given the opportunity NHS managers will cut back to the last doctor and nurse before cutting other bureaucrats.
    In the private sector where the money only comes from selling things or providing services, management always tries to protect the earning part at the expense of overheads.

  13. Acorn
    July 26, 2010

    Worry not, it will all end well and in the private sector 😉 Primary care is on its way to the private sector. PCTs will be abolished; GPs will become their own procurement officers. Most GPs don't want to be commercial administrators; they did not go into primary care medicine to do that. Some, who can't stand dealing with the great unwashed will love it, and see an opportunity.

    So, the GPs will appear to fail at this task. The organisations they currently buy hip ops and other secondary care from, will then morph into GP employers. Privatised primary care; simples!

  14. John Hatch
    July 26, 2010

    The NHS is (infiltrated with people) who have not the least interest in patients' health, let alone effective and efficient ways of procuring it. These people see the NHS as a state organisation to be exploited for spreading marxoid and mischievous ideas that will undermine our traditional way of life. Look at the way in which the NHS has been exploited to stir up trouble over so-called 'domestic violence' (defined not as 'assault' but as anything disapproved of by an extreme feminist) and thereby de-stabilise marriages. Ask why nurses will soon need to have degrees – if this is not merely to indoctrinate them with marxoid concepts of 'equality and diversity' while providing cushy jobs for lefties at the former polytechnics. These are just two examples. The(se people) must be giggling behind their hands as they watch the coalition government fiddle around the margins of the problem whilst getting brickbats hurled at them.

    Reply: Trying to prevent further violence in a marriage is surely a worthwhile task?

  15. FaustiesBlog
    July 26, 2010

    Seems to me that the Health authorities are trying to derail Lansley's programme, in much the same way as civil servants tried to derail Gove's programme (embarrassing list errors of schools).

    Lansley should find out how many management jobs and unnecessary departments are for the chop. Should he find that management is not being cut to an acceptable level, heads should roll. He must make an example out of these people, before others get on the bandwagon.

  16. NickW
    July 26, 2010

    The problem may well be that Foundation trusts have used their independence to borrow themselves up to the hilt and now have loans which they cannot refinance.
    Any manager who cuts services should be summarily dismissed.
    Ordinary people are denied any kind of treatment on the NHS and suffer continual pain as a result. It would be more humane if the NHS did not actually exist so that patients were not continually tormented by an expensive illusion which balances its books by denying patients diagnosis or treatment.

  17. A.Sedgwick
    July 26, 2010

    Whilst there is litte doubt that there are too many NHS managers and adminstrators the frustration of doing anything substantial in such a monolith should also be recognised. As with education the role model is there in the private sector, at least Michael Gove is on the right track in making schools self governing and more independent.
    The BMA is a tough trade union; too many people expect too much from the NHS, it was set up for the sick and injured not for the childless, obese and frivolous cosmetic surgery.
    People need to be encouraged to take out medical insurance, visits to a GP should have a nominal charge with the usual exemptions, doctors should either work for the NHS or privately – no conflict of interests and the contracting out of NHS work to private hospitals should be widespread.

  18. christina sarginson
    July 26, 2010

    Cutting public spending is all very well providing it does not affect health and safety when the emergency services cant do their job due to lack of resources we need to think what is happening to our green and pleasant land.

  19. forthurst
    July 26, 2010

    The way to deal with hospitals and other public sector organisations that attempt to damage the service provided to the public in order to achieve political point scoring or otherwise as a result of incompetance, is to put them into administration. That would also act, "pour encourager les autres". Adminstrators could sack incompetent, obstructive or over numerous managers and their secretariats and reform and replace inefficient support systems and services.

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