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This report examines in detail the 2004-05 revenue situation of NHS organisations and considers key financial management and reporting issues facing the NHS both currently and in the future. Jointly prepared by the National Audit Office and the Audit Commission, the report incorporates the findings of their audit work on the NHS summarised accounts, the consolidated account of NHS foundation trusts, the Department of Health's resource account and the accounts of individual NHS organisations, as well as the unaudited NHS revenue out-turn for 2005-06 as reported by the Department of Health and Monitor. Findings include that in 2004-05, the Department reported a deficit across the NHS as a whole for the first time since 1999-2000, with an aggregate overspend for all NHS bodies of £251.2 million, with 171 out of 615 bodies recording a deficit or overspend, with 68 out of 259 NHS trusts failing to break even, and with 90 out of 303 primary care trusts exceeding their revenue resource limits.
Spending on the NHS is the fastest growing area of public expenditure, with a budget for 2004-05 of £69.7 billion, rising to £76.4 billion in 2005-06 and £92.6 billion in 2007-08. Despite the increased resources, the NHS reported an overall deficit of £251 million (including Foundation Trusts) in 2004-05, the first time since 1999-2000 that the NHS as a whole had overspent. In 2005-06, the overall deficit increased to £570 million, with a rise in both the number of NHS organisations (Strategic Health Authorities, Primary Care Trusts, NHS Trusts and NHS Foundation Trusts) reporting a deficit and the proportion of those bodies reporting a deficit. Following on from a report (HC 1059-I, session 2005-06; ISBN 9780102938159) published in June 2006, jointly prepared by the National Audit Office and the Audit Commission, the Committee's report examines three main issues: the factors that led to the deficits, the impact on the organisations involved, and the steps taken to recover the deficits. Amongst its findings, the Committee concludes that there are a number of reasons why NHS bodies are in deficit, with most organisations in deficit tending to have had a deficit the previous year. Bodies already in deficit looking to turn their financial position around can be disadvantaged as they are expected to recover that deficit in the next financial period. The NHS has been under significant financial pressure to meet the costs of national pay initiatives which the Department of Health had not fully costed, and as some NHS bodies have coped better than others in managing these cost pressures, this indicates that the standard of financial management expertise varies across the NHS, as does the level of clinical engagement in financial matters.
Written for new and existing managers, undergraduate and postgraduate students of the public services, this essential textbook explores the meaning and significance of financial management for the public services, in a way which combines both theoretical arguments and practical applications. Written for the non-specialist, it: * examines the economics of public services * considers the extent to which the management of public services has actually changed in practice * explains the meaning and applicability of financial management tools including those relating to budgets and capital investment * presents original work on the issue of audit expectations * presents case studies on the problems which can arise when traditional concerns on probity and stewardship are neglected * considers the benefits and problems of measuring performance in the public services * includes specific chapters on financial management in health services and local government
This book introduces non-financial managers in the NHS to the concepts and application of financial techniques. In this period of fundamental change in the NHS, managers of all sorts should find this book a lifeline. The authors' extensive experience running courses on financial management for health service professionals has enabled them to write an accessible and down-to-earth book of enormous practical value.
This public inquiry report into serious failings in healthcare that took place at the Mid Staffordshire NHS Foundation Trust builds on the first independent report published in February 2010 (ISBN 9780102964394). It further examines the suffering of patients caused by failures by the Trust: there was a failure to listen to its patients and staff or ensure correction of deficiencies. There was also a failure to tackle the insidious negative culture involving poor standards and a disengagement from managerial and leadership responsibilities. These failures are in part a consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status at the cost of delivering acceptable care standards. Further, the checks and balances that operate within the NHS system should have prevented the serious systemic failure that developed at Mid Staffs. The system failed in its primary duty to protect patients and maintain confidence in the healthcare system. This report identifies numerous warning signs that could and should have alerted the system to problems developing at the Trust. It also sets out 290 recommendations grouped around: (i) putting the patient first; (ii) developing a set of fundamental standards, easily understood and accepted by patients; (iii) providing professionally endorsed and evidence-based means of compliance of standards that are understood and adopted by staff; (iv) ensuring openness, transparency and candour throughout system; (v) policing of these standards by the healthcare regulator; (vi) making all those who provide care for patients , properly accountable; (vii) enhancing recruitment, education, training and support of all key contributors to the provision of healthcare; (viii) developing and sharing ever improving means of measuring and understanding the performance of individual professionals, teams, units and provider organisations for the patients, the public, and other stakeholders.
NHS Deficits : Sixth report of session 2005-06, Vol. 2: Written Evidence
This book is intended to give readers detailed information and perspectives on the reform of financial management reform practices in a variety of national settings around the world. The chapters explore the reform agenda in each nation and factors that stimulated change. Each chapter addresses the extent of the influence of "New Public Management" concepts and practices on reform implementation. The nations whose experience is represented in this book are among the most often cited examples of progressive change to be examined and perhaps emulated by governments in other nations. In the introductory chapter the editors address the question whether and to what extent the financial management reforms detailed in the book reveal real progress or a progression of questions and dilemmas faced but not solved over the past several decades.
The Government's fiscal consolidation programme is now expected to last longer than originally planned, and wide-ranging service reforms are being implemented. The role of financial managers is therefore critical to ensuring that opportunities to improve value for money are realized. The Finance Transformation Programme has been set up to develop the skills and capabilities of finance professionals, and qualified professionals are better represented at senior levels. However, given the importance and urgency of the challenges presented by fiscal consolidation and public service reform, further improvements will be needed to support sustainable public service delivery with fewer resources in the longer term. Government is a long way from ensuring that decision-making is routinely based on robust information. Departments often do not integrate financial management with their strategic and operational planning. Departments and other public bodies have generally managed within reduced spending limits up to now, but some of the savings they have made are more sustainable than others. In order to respond to financial and demand challenges, government needs to go further than controlling spending, by redesigning public services so that they operate permanently at lower cost. The NAO recommends that the Treasury ensure a more effective leadership to better enable and incentivise the finance profession to confront the challenges it faces. The Government's Finance Leadership Group should take responsibility for diagnosing the key current financial management challenges facing the finance profession and the wider civil service, and for addressing them quickly
Productivity in hospitals has been falling by around 1.4 per cent a year since 2000 whilst NHS expenditure has increased by over two thirds in ten years. The Department of Health has achieved significant improvements in such areas as waiting times, healthcare associated infection rates, patient outcomes, reduced cancer mortality and the patient experience. However, the NHS pay contracts introduced since 2003 have increased costs but are not always used effectively by hospitals to drive productivity improvements. The NHS needs to deliver between £15 billion and £20 billion of efficiency savings per year by 2013-14. Around 40 per cent of these savings are expected to come from increasing efficiency in hospitals, requiring productivity gains of approximately six per cent per annum. The 'Payment by Results' system of setting national tariffs has promoted some efficient practice, but there is still substantial variation between hospitals. If all hospitals performed at the level of the top 25 per cent in respect of staff costs, use of estate, control of emergency admissions and bed management, the NAO estimates that the NHS could save around £1.6 billion a year. The Department has launched a national initiative (QIPP) to help the NHS deliver annual savings of up to £20 billion. There are risks to the delivery of the initiative, which is the responsibility of Strategic Health Authorities and Primary Care Trusts, whose focus may be distracted by the proposals for their closure by 2013.