The public finances are under pressure like never before. Whoever wins the election will be forced to make cuts, to prioritise services and find yet more efficiency savings.
Every penny counts – as MPs are finding to their personal cost – and it is vital that budgets are managed properly and accurately. This is particularly so in the health service, which represents one-third of total government spending in England.
It’s reassuring, therefore, to see the results of the Care Quality Commission’s survey of acute, specialist and primary care trusts. The newly created watchdog found improvements in waiting times, hospital infections and commissioning. It also noted a huge step forward in financial management.
More than 100 trusts (26%) are ranked as ‘excellent’ for financial management, while 45% are described as ‘good’. This is markedly better than the previous year’s performance and is part of a consistent trend of improvement.
We have come a long way from the mid-2000s when the NHS as a whole was making a substantial deficit and facing difficult questions about its financial competence. This year, in a much tougher environment, a surplus approaching £1.5bn is forecast.
Of course, there are still those whose performance is not up to scratch. The CQC identified 11 trusts whose management of their finances was ‘weak’. Disappointingly, seven acute trusts, six of them in London, have been labelled ‘weak’ for four years running.
Progress has clearly been made on financial management and on quality more generally, but there has to be no let-up and no exceptions. And it’s not just the finance department that has to grasp the nettle.
As Andy McKeon, the Audit Commission’s managing director of health, told a CIPFA conference this week, there is a danger of casting finance directors in the role of ‘hero’. Too often, public sector employees see budgets, costings and productivity as the sole responsibility of the suits in the finance department.
But, as McKeon stressed, finance and efficiency need to be everybody’s business. The health FD will have to take on a wider communications role encompassing staff education and engagement.
And, in this harsh financial climate, everyone will need to redouble their efforts to make sure trusts do not slip back to their bad old ways.
It’s a brave new world, in which everyone has the opportunity to be a hero. But, hopefully, for more than one day.
