Leading article: The need for radical surgery

Share

After the sudden departure of the head of the NHS, Sir Nigel Crisp, one question is left hanging in the air. What can his successors do to bring the spiralling NHS deficit under control that he had not already tried?

For the best part of four years following his appointment to the top job in November 2000, Sir Nigel presided over an NHS that was growing at a record rate and hit all its targets, including cutting waiting lists to a historic low and reducing heart and cancer deaths.

Tony Blair, the Health Secretary, Patricia Hewitt, and leaders of NHS organisations paid tribute to his achievement yesterday. But when things started to go wrong in the middle of 2005, the writing was on the wall. Having lost the confidence of ministers and of senior managers in the health service, Sir Nigel knew there was no option but to fall on his sword.

Despite all efforts to curb the overspending, the overall NHS deficit was heading in the wrong direction at the start of this year when it was projected at £790m, up from £620m last October, by the end of this month. That leaves Sir Nigel's successors - his job has been split between an experienced NHS manager, Sir Ian Carruthers, and a senior civil servant, Hugh Taylor, while the Health Department searches for a permanent replacement - between a rock and a hard place. They must deliver on the Government's pledges, notably to cut waiting times to 18 weeks by 2008, while balancing the books.

A sign of the tougher financial regime that is now in prospect comes in the memo from John Bacon, head of NHS finance, telling London primary care trusts that 3 per cent of their cash allocation for next year will be held back to fund any future deficits. Hospitals are warned that if they progress too fast in cutting waiting lists they will not be paid. And the £1.1bn redevelopment of Bart's and the London, the NHS's biggest privately financed project, given the go-ahead by Patricia Hewitt yesterday, is to have three wards mothballed, saving £20m year, pending proof that they are needed.

But stricter financial discipline is only part of the answer. In many of the trusts facing the biggest deficits, there are long-standing structural problems that have for too long been avoided - hospitals or departments in the wrong places that call for mergers and closures to improve efficiency.

Surrey and Sussex, West London, Hertfordshire, Avon and Gloucestershire, Kent, Lancashire and Yorkshire are among the areas where radical surgery is needed. The Prime Minister urged local managers to "grasp the nettle" in reshaping services in a recent speech. Until they do, a long-term answer to NHS overspending will evade them.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

Tradewind Recruitment: English Teacher

Negotiable: Tradewind Recruitment: This post arises as a result of the need to...

Tradewind Recruitment: Class Teacher Required ASAP In Uminster

£120 - £150 per annum: Tradewind Recruitment: I am recruiting on instruction o...

Ashdown Group: Head of Finance - Financial Director - London - £70,000

£70000 per annum: Ashdown Group: Head of Finance - Financial Controller - Fina...

Ashdown Group: Marketing Executive - Wimbledon, SW London

£24000 - £28000 per annum + benefits: Ashdown Group: Marketing Executive - Wim...

Day In a Page

Read Next
 

I’m not sure I fancy any meal that’s been cooked up by a computer

John Walsh
Labour leader Ed Miliband delivers a speech on his party's plans for the NHS, in Sale, on Tuesday  

Why is Miliband fixating on the NHS when he’d be better off focussing on the wealth gap?

Andreas Whittam Smith
Isis hostage crisis: Militant group stands strong as its numerous enemies fail to find a common plan to defeat it

Isis stands strong as its numerous enemies fail to find a common plan to defeat it

The jihadis are being squeezed militarily and economically, but there is no sign of an implosion, says Patrick Cockburn
Virtual reality thrusts viewers into the frontline of global events - and puts film-goers at the heart of the action

Virtual reality: Seeing is believing

Virtual reality thrusts viewers into the frontline of global events - and puts film-goers at the heart of the action
Homeless Veterans appeal: MP says Coalition ‘not doing enough’

Homeless Veterans appeal

MP says Coalition ‘not doing enough’ to help
Larry David, Steve Coogan and other comedians share stories of depression in new documentary

Comedians share stories of depression

The director of the new documentary, Kevin Pollak, tells Jessica Barrett how he got them to talk
Has The Archers lost the plot with it's spicy storylines?

Has The Archers lost the plot?

A growing number of listeners are voicing their discontent over the rural soap's spicy storylines; so loudly that even the BBC's director-general seems worried, says Simon Kelner
English Heritage adds 14 post-war office buildings to its protected lists

14 office buildings added to protected lists

Christopher Beanland explores the underrated appeal of these palaces of pen-pushing
Human skull discovery in Israel proves humans lived side-by-side with Neanderthals

Human skull discovery in Israel proves humans lived side-by-side with Neanderthals

Scientists unearthed the cranial fragments from Manot Cave in West Galilee
World War Z author Max Brooks honours WW1's Harlem Hellfighters in new graphic novel

Max Brooks honours Harlem Hellfighters

The author talks about race, legacy and his Will Smith film option to Tim Walker
Why the league system no longer measures up

League system no longer measures up

Jon Coles, former head of standards at the Department of Education, used to be in charge of school performance rankings. He explains how he would reform the system
Valentine's Day cards: 5 best online card shops

Don't leave it to the petrol station: The best online card shops for Valentine's Day

Can't find a card you like on the high street? Try one of these sites for individual, personalised options, whatever your taste
Diego Costa: Devil in blue who upsets defences is a reminder of what Liverpool have lost

Devil in blue Costa is a reminder of what Liverpool have lost

The Reds are desperately missing Luis Suarez, says Ian Herbert
Ashley Giles: 'I'll watch England – but not as a fan'

Ashley Giles: 'I'll watch England – but not as a fan'

Former one-day coach says he will ‘observe’ their World Cup games – but ‘won’t be jumping up and down’
Greece elections: In times like these, the EU has far more dangerous adversaries than Syriza

Greece elections

In times like these, the EU has far more dangerous adversaries than Syriza, says Patrick Cockburn
Holocaust Memorial Day: Nazi victims remembered as spectre of prejudice reappears

Holocaust Memorial Day

Nazi victims remembered as spectre of prejudice reappears over Europe
Fortitude and the Arctic attraction: Our fascination with the last great wilderness

Magnetic north

The Arctic has always exerted a pull, from Greek myth to new thriller Fortitude. Gerard Gilbert considers what's behind our fascination with the last great wilderness