The Friday Blog: Big Enough to Know, Small Enough to Care
Despite the fact that the decorations round our way have been going up with gusto for at least three weeks now, I am struggling to feel at all festive. Daughter is trying and did an amazing job last weekend, although I think that has as much to do with the fact that it was a more preferable activity than revising for her mock GCSEs. It is probably because our NHS journey continues apace, another premature discharge, another readmission, another spell in the ED. All resources that could have been saved had we got it right first time as someone might have said.
I had dinner with the CEO of a DGH and related our experiences. He was incredulous and reminded me again that bigger is not always better. There are, of course, economies of scale associated with the behemoths that are our typical tertiary centres, and they tend to attract the talent, medical and management. But they also lose something in the way of having a sense of common purpose, being truly caring environments. The Doctor told me this a few years ago when she first utilised the Royal Orthopaedic Hospital in Birmingham, having experienced services at all the other Trusts in the city. Subsequently I have noticed that those Trusts that top the charts in patient satisfaction are regularly small, specialist centres. A combination of that common purpose, being really good at what they do, and not having an ED conspire to deliver outstanding care.
If you end up having to spend Christmas in hospital (watch this space) maybe your wish would be to spend it in one that is big enough to know what it is doing, but small enough to care. Estates managers everywhere got an early present with the news that The NHS will be banned from raiding capital budgets to fund revenue gaps under new Treasury rules.
It follows after nearly £900m and £1bn have been moved from capital to revenue budgets in the past couple of years, in part to cover pay, strike and technology pressures. The news comes as the government said it would no longer allow capital raids to fund pay awards across the entire public sector, in evidence to the pay review bodies this week. The evidence said: “The government has changed the fiscal rules to remove the incentive to make these kinds of switches, and will be changing the consolidated budgeting guidance to explicitly rule them out.” It said the move meant departments will have to live within their means. So that is alright then.
However, it is understood that the fiscal change will affect capital budget raids to fund pressures beyond just pay, and prevent the practice where capital budgets are reduced with the intention of covering revenue gaps. It is also believed that technical transfers, for example, to cover the transfer of leases from capital to revenue or expenditure on some tech projects, are considered to be exempt because this expenditure is being reclassified for accountancy purposes, rather than representing a genuine capital to revenue raid.
Confirmation of the rule change follows the Department of Health and Social Care’s director general for finance Andy Brittain telling the Public Accounts Committee earlier this month that capital raids had been “immediately ended”. The practice has been widely criticised, including by Lord Ara Darzi, who highlighted the impact of “capital starvation” on poor NHS performance in his report this year. Health Secretary Wes Streeting said he was determined to “break the vicious cycle” of taking money from capital investment to plug revenue pressures earlier this year. A Treasury spokesman said: “Under the new current budget rule, the government must balance day-to-day spending with revenues, ensuring that borrowing is only used for investment purposes. This is a shift from the old public sector net borrowing rule, which incentivised reducing investment in order to balance the budget by allowing day-to-day costs to exceed revenues and making up the difference through borrowing. The new rule eliminates this incentive to cut investment, promoting a more sustainable fiscal approach.”
I am going to truncate my usual ramblings this week and allow you all to reflect on what has been another seismic year for our sector. From regulation to procurement, dodgy NICE assessments to even dodgier social value assessments it has been quite a ride again. January will be an absolute sprint to ensure our voice is heard in the development of the Life Sciences Sector, 10 Year Health and Trade Plans, amongst other things. Indeed, before Andrew, Luella, Peter and I can settle down for the festivities, we will be on duty at various meetings under the auspices of the Life Sciences Council.
But no need to feel short of reading this week – my old mate and Dublin Policy and Communications specialist Dave Curtin has delivered the guest blog I promised you last time, considering the fallout from the Irish elections and the implications for the rest of us on the UK / EU border. Enjoy it here and have a peaceful festive season, hopefully spent with the ones you actually really do want to be with.
