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There is voodoo and black magic. There is even legerdemain and conjuring. For some of us these dark arts are as nothing compared to NHS finance.
Really, NHS finance is just like managing a family budget; if the money-out is greater than the money-in... the result is ramping up the credit card, pay-day loans, a second job, sell the house or sell the kids. None of which is a good idea.
In the NHS, if the money-out is greater than the money-in, the result is more or less the same; a bung, borrowing, cranking up private work, flogging off a bit of the estate or sacking nurses. None of which is a good idea.
Finance is really simple. If you don't have enough money you have to stop doing stuff. In the NHS that means longer waiting lists, staff getting the chop, quality down the pan and we end up going to hell in a hand cart.
The highest paid executive in the NHS, David Bennett, the increasingly morose boss of the most superfluous organisation ever invented, Monitor, announced on Friday that Trusts were bust. Quite how 'bust' I don't think he knows.
As the fragrant Jenifer put it, in the Health Foundation's Press release:
" ... the deficit for FTs has risen to a total of �321m (ytd)... combined with the latest... from TDA... the total deficit for all providers is now over �700m..." (More here).
Three quarters of hospitals can't balance their books and if you sum the totals for all trusts, we are out by �859m. I wouldn't mind betting it is really more.
Despite mid-year bungs from the DH, Trusts have got about as much chance of balancing the books by 1st April as a shopper has of getting through a supermarket self-checkout without hearing 'unexpected item in the bagging area'.
... and do you know something... I couldn't care less. Why does it matter? It only maters to the politicians. The Tories who have pretended the NHS has had more money and more staff and more of everything. It matters to the Labour lot who will crow about failure.
They would all do well to remember there are 1.4 million votes at stake in the NHS. In some marginals it is the votes from nurses that could decide the outcome.
Finance doesn't matter anymore because anyone with half a brain can see; somebody is going to have to put some proper money on the table.
As Circle, Serco and BUPA will tell you when 3/4s of the NHS is skint; there's no money in health.
Bennett's mishandling of the tariff fiasco, is more proof. Trusts gave Monitor the finger and said go away and think again; this is a price at which we can't deliver care... never mind safe care.
Tarzan has given Bennett the elbow, taking the issue away from Monitor, giving health economies money, direct. It is the only sensible decision. Tarzan has said get on with it. Well done him. The alternative would be a Bennett-fest of more consultation and a Barney with the competition numpties.
Just like relentless CQC reports, about poor provider performance, no longer have any impact (everybody is in the same boat) so failing to balance the books doesn't matter No one can! Short of stop-doing-things and sacking people here is nothing to be done.
Flat line funding against a 4% growth in demand has wreaked havoc with NHS stability. Even Tarzan's targeted 2-3% efficiency gain wouldn't make a big enough impact on the shortfall.
The NHS will, this week, like every week, struggle and muddle along doing the best it can to do... to do the best it can do. And that is all that matters. The patient facing, front line will soldier on, regardless.
The counters don't count any more. There is nothing to count. We may as well close the finance departments with their planners and plotters; they are all bystanders... ornaments. All they can do is count what we don't have and there is no point to that.
Solutions? Dump commodious Monitor and his mad-market that gives zero ROI. Introduce an allocation model; population based, capitated budgets. Scrap the mostly bewildered CCGs and invent something aligned with Local Authorities, where all local people and organisations can have a say.
I think they are called a health authority.
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'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.
Kings Fund 11th March - details here.
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roy.lilley@nhsmanagers.net
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