Your heart will beat faster to get blood to your body. Your muscles will become tense and ready to spring into action. You will be breathing faster, your pupils will dilate to take in more information and as the adrenalin kicks in... you'll sweat.

Now, you are scared. What of? Glossophobia, arachnophobia, claustrophobia, acrophobia, astraphobia, dentophobia, nyctophobia, ophidiophobia?

Me? I'm phobophillic! Well, I was. Not now; I have met the world's scariest woman. She has a black-belt in terrifying. This woman is deeply disturbing and very distressing. Disconcerting doesn't do it. She is just plain petrifying. I have succumbed to Anitaphobia. She's scared the bejesus out of me.

I officially declare Anita Charlesworth, economist, formerly of the Nuff's and now with the fragrant Jennifer at the Health Foundation, to be the world's most bloodcurdling woman.

When Mistress Charlesworth writes about NHS finances you would do well to read every word. When she speaks, sit quietly and listen. Don't make eye contact; she might transmogrify you into something grotesque.

Her latest message, to the great mass of the unwashed, is almost too gruesome to speak of. I can only write about it in hushed tones. Typing quietly and deliberately; there is a chill hanging over me.

Mistress Charlesworth has turned her calculator brain to considering NHS finances and the tale is almost too bad to tell. It makes Edgar Allan Poe look like the writer of fairy tales. Stephen King the sort of man who writes greetings for Hallmark. H.P.Lovecraft, a copy writer for a dating agency. Lon Chaney would decline the script and Boris Karloff wouldn't read it.

Charlesworth's latest blood curding billet-doux looks at NHS provider performance, efficiency and productivity. And, it is dire.

I lived in the cuddly, comfortable world where I thought as the NHS sweated, heaved, strained, pushed and pulled, against all odds, this would translate into levels of performance and productivity that would be the envy of an Zambian copper mine; not so.

The financial performance of NHS providers in England has gone down the tubes; from a net surplus of �582m in 2012/13 to a net deficit of �789m at the end of Q3 of 2014/15.

Despite an expected under-spend from commissioners of �197m, the NHS is projected to overspend by �626m by the end of 2014/15.

If you are of a nervous disposition and already feel the hairs on the back of your head prickling... don't read this next bit.

NHS hospitals have only improved efficiency at an average rate of 0.4% a year over this parliament.   Aaaargh... a blood curdling scream drowns out the prayers of the innocent. We are doomed.

There are three issues that arise from this debacle.

Staffing and staffing costs are the biggest driver of rising operating costs. Spending on temporary staff grew by �1bn (27.8%) in 2013/14 and continues upwards. Acute hospitals are hardest-hit: 76% were in deficit at the end of Q3 of 2014/15, up from 19% in 2012/13.

These Hospitals' crude productivity fell by almost 1% in both 2012/13 and 2013/14 and only improved efficiency at an average rate of 0.4% a year over this parliament.

The catastrophic combination of; miscalculations in workforce planning, the dread following the Francis Report and the fruitless stomping around by the CQC telling everyone they don't have enough nurses is driving panic in recruitment and cost inflation in the agency sector.

The solution, consolidate the temporary posts, but it will be impossible without a root and branch rework of Agenda For Change, working conditions, roistering, family friendly employment policies and a genuine desire to make hospitals happy places to work. That means sorting complaints and whistleblowing.

The next casualty will be the Five Year Forward View; predicated on productivity efficiencies of 2-3% a year. From a 0.4% base line this is impossible without investing to modernise and a demolition of existing structures and hangers on.

The final brick in the wall Charlesworth kicks over is the politicians' belief that �8bn funding over the next spending cycle is close to providing a solution. It is nowhere near enough. It might be enough to help keep the lights on.

Politicians need to start looking for something around a blood curdling �20bn and then we need to talk about social services and then we need to talk about, horror of horror, taxes. 

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Sir Robert Francis,

in conversation with Roy Lilley 

Details here 

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