The increasing number of hospitals reporting deficits has put the spotlight on what happens when NHS providers are in financial difficulty. In his audio slideshow, Richard Murray explores the current financial health of the NHS, the options for managing financial failure and recommendations for the future.
Whilst I would not disagree with the majority of Richard's presentation I do wonder whether the approach is overly academic. For example, did you consult with people like me who have worked in financially challenged trusts? I have been doing this since 2005/06 (6 acute and one CCG) albeit I have been an FD since 1992. One of the main problems in 2005/06 was the inequity of the funding regime; most starkly illustrated by the 'cliff edges' created by the MFF. The Audit Commission did not appear to highlight this as a major contributory factor at the time of its report on the causes of the overspending despite the evidence of a correlation with these funding imbalances. As you acknowledge, the current difficulties are not 'in times of plenty' albeit funding imbalances are still a factor. For example, in Education & Training funding and the absence of PbR in MH trusts. Evidence for the latter can be seen in the relatively small number of MH trusts in financial distress (you should also look at their cash balances!). The 'lack' of strategic leadership may be overplayed; the bullying culture in the NHS has not gone away and more of what I have seen and, been personally affected by, will not help unless the leadership has the right values. You could do worse than talk with someone like me who has direct experience at the sharp end!