Editor's Comment


Getting out of the red

Source: NHE Nov/Dec 15

As NHE was going to press, the government announced some substantial extra funding for the NHS, frontloaded – as requested by NHS England’s Simon Stevens and others – to the early years of this Parliament. 

The money was welcomed, though the government did not expect and did not receive gratitude – many in the NHS think this is the minimum necessary just to maintain services at their current level, in the face of growing demand. The real key is ringfenced money for transformation, some say. 

The NHS balance sheet must have created some sleepless nights at the Treasury. With every single acute in deficit (news story on p6), the situation was clearly not a case of poorly performing organisations not doing enough to improve efficiency or wasting money – even the best-rated exemplar trusts are obviously in serious financial straits. The picture is hardly rosier in the other sectors – mental health in particular is struggling, public health is facing in-year cuts, and social care is, if anything, in a bigger financial crisis than the NHS. An extra precept on council tax is unlikely to do much to change that. 

Many of the articles in this edition of NHE feature ideas for improvements, a good proportion of them potentially money-saving and quality-improving: from foundation chains to co-location of A&E and primary care services, and from medical leadership of the value-for-money agenda to procurement and supply chain innovation. 

We also have an investigation by my colleague David Stevenson into medication errors in the NHS based on Freedom of Information findings (p54), and an interview by Luana Salles with shadow mental health minister Luciana Berger MP (p20). 

Our cover story relates to an always-thorny issue: health workers’ own health. When does NHS promotion of healthy lifestyles for staff go too far? Is it ethical for candidates for NHS jobs to be rejected for what they do on their own time, whether that be smoking or simply choosing not to exercise? It’s not unheard of – the Cleveland Clinic in the US does not employ smokers, for example. 

Few would question the idea that the NHS should help staff make healthier choices, and therefore to be better role models when giving public health advice. But turning this from a choice into something mandatory crosses an important line. 

Have a read of the pieces by Siva Anandaciva, head of analysis at NHS Providers, on pages 16-17 and by Professor Annie S Anderson, professor of public health nutrition at the University of Dundee, on page 67 – and tell us what you think.

Adam Hewitt



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