A notable format regulator and NHS trust chair has described the way that the additional funding is allocated within the NHS as “economic lunacy and grossly unfair”.
Sir Peter Dixon has been chair of multiple NHS trusts, including University College London Hospitals Foundation Trust for nine years, as well as former housing regulator the Housing Corporation.
And this credentialed individual believes that the rules almost inevitably result in dishonesty throughout the NHS system.
It is now known that nearly £2 billion of sustainability and transformation funding has been distributed in the 2016/17 financial year.
Yet there is significant inequality within the system, with massive disparity between the payments made to individual organisations within the NHS.
STF roles have been heavily geared towards ensuring that trusts achieve their controlled totals, in an NHS system that has perpetually run up financial deficits.
However, this has resulted in clear winners and losers in terms of income received, and many believe that the existing system harbours inequality.
In some cases, trusts could secure extra payments via accounting adjustments or land sales, while many of those that missed out had to take out interest bearing loans.
And Dixon pulled no punches in his comments, noting that “giving more resource to asset-rich organisations while squeezing those already struggling is economic lunacy and grossly unfair. It also demotivates those with some of the hardest jobs in the system.”
The former trust head went on to outline further criticisms of the existing system.
“If trusts are hitting their control totals because they’ve done prudent things and made genuine efficiencies then that’s justified, but if you’re suddenly pulling a rabbit out a hat in quarter four when your board reports throughout the year have suggested a big overspend, then it’s usually dirty work at the crossroads.”
In this context, it is perhaps not surprising that murmurings of cooking the books within NHS trusts are far from infrequent.
Technical accounting measures ensured that the deficit of trusts was around £800 million in the most recent financial year, but this would have exceeded £1.2 billion without special measures that cannot necessarily be repeated in the future.
And Dixon asserted that this is leading to massive problems for staff working within the system.
“Everyone that I talk to says there’s a lack of honesty in the system because if people are honest they get bullied. Therefore no one is doing the right things. I would contend there’s no point in putting more money into the system until we get rid of that dishonesty in terms of the reporting and the bullying from the top.”