NHS Managers lay the blame at door of Labour govt

Government targets and badly costed pay schemes are largely to blame for the financial problems in the NHS, chief executives believe. Eighty-four per cent of respondents to HSJ's survey agreed with the statement that the government was trying to dodge its own culpability for the financial problems by blaming it on a small number of poorly performing trusts.

More than two-thirds of chief executives said the NHS would not be facing such severe financial problems if it were not for 'inflexible government targets' such as the four-hour accident and emergency wait.

And 99 per cent agreed that Agenda for Change and the consultant and GP contracts were not costed effectively by the Department of Health, and that this has had a big impact on the financial state of the NHS. Eighty-six per cent agreed strongly with the proposition.

One respondent to our survey of mental health, acute and primary care trust chief executives said: 'In 30 years I have never experienced such chaos and paralysis and I hold ministers and the DoH absolutely responsible.'

Another said: 'The DoH is responsible for negotiating Agenda for Change and the consultant and GP contracts so it should be accountable for the financial consequences,' he added.

Another asked: 'Who in their right mind would ever give their staff a pay award before agreeing what the productivity improvement will be?'

The 'short-term nature' of NHS targets was singled out for criticism by one, and another said: 'The government has put too many changes in place at the same time without considering the impact on the service. Targets are set nationally; locally we try and meet these and then we get the blame when the targets and funding don't balance.'

NHS Confederation policy director Nigel Edwards agreed that targets were costing trusts more than expected. 'Some places have discovered that they are experiencing diminishing returns in meeting the targets. One strategic health authority has told me that it cost £15m just going from the 95 per cent to 98 per cent A&E target, and it cost one trust £1m alone.'

Only 39 per cent of chief executives believed that the calibre of finance directors is a major factor. One senior figure said the government was wrong to blame management failings for the financial crisis: 'If it is a failure of management, the system put these managers there, they appointed them and are responsible for holding them to account.'

Chief executives also blamed the introduction of the private sector for the problems: 66 per cent said the policy had destabilised parts of the NHS.

SHAs accused of piling debts on 'bad apples'
Debts are being heaped on trusts by some strategic health authorities so the financial crisis can be put down to a 'few bad apples', King's Fund chief economist John Appleby has claimed.

Questioning the credibility of SHA projections to the Department of Health, Mr Appleby said some authorities 'centralised' their deficits because the pressure to present a reasonable picture to the government was 'immense'.

'The reality is that most, if not all organisations are suffering to some degree financially. If you have got 10 hospitals in an area and they all have a deficit of £2m that could look worse than if you have two with a £10m deficit each,' said Mr Appleby.

'It implies something about who is to blame. If you have just a couple of hospitals with big deficits you can start to say it's bad management. If every hospital had a deficit it would send out a different message. The finger could start to point upwards in the system.'

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