Hush, hush whisper who dares?

When you are a parent you quickly learn from the toddler stage right up to late teens – if they’re not making a noise, they’re probably up to no good. As you try to track down your silent, but potentially deadly offspring you hope that whatever you find won’t involve too much mess or damage or a trip to accident and emergency department.

Speaking of which…

There is an uneasy quietness about all things NHS at the moment. Yes – it’s the silly season for news, and of course recent yobbish behaviour in the UK and the global financial challenges are taking up most of the serious headlines. But as our attention is briefly diverted – the time bomb known as the Health and Social Care Bill continues to tick….

Sitting quietly and unobtrusively in the House of Commons, the controversial Bill faces one more report stage and final reading on the 6^th and 7^th September. Then the NHS reform plan, the rather bloodied and bruised brainchild of Andrew Lansley, UK Secretary of State for Health, will start its journey through the House of Lords. This could be interesting and I suspect there is little chance of simple rubber stamping at this stage.

In the meantime, what’s happening at the coalface?

Yes, there is still a huge amount of excellent care being provided by many well-managed units across the patient pathway. But signs of financial pain, limited resources and most of all, a creeping (or is it galloping?) uncertainty are beginning to show.

The audit commission has warned that a quarter of NHS Trusts have ‘notable weaknesses in their arrangements for securing financial resilience’. Although £4.3bn savings were delivered in 2010/2011 through ‘clinical productivity and efficiency’ 19% of targeted savings were not achieved.  It was judged that 23% of savings were ‘one-off fixes’ such as temporary recruitment freezes, and not long term strategy.

This coming fiscal year will be much tougher and the audit commission states ‘Organisations that have up to now managed their finances well will find financial pressure increasing as the need to deliver high quality services without the funding growth will begin to impact’ .

Jo Webber, deputy director of the NHS Confederation fears that this could be ‘the calm before the storm. Many of our members have told us that they are expecting the financial situation facing their organisations to be the worst they have experienced’

All this in the context of ever increasing demand on resources.

So that’s what the silence is – people holding their breath as they tighten their belts…