PAC does not make the connection explicit, but I will: their diagnosis of DHSC's "addiction" to raiding capital budgets is directly contributing to that slow productivity recovery I'm sceptical that this practice will stop, despite change in HMT regulations. We've heard that one before - ThreadSky

stuarthoddinott.bsky.social • 58 days ago

PAC does not make the connection explicit, but I will: their diagnosis of DHSC's "addiction" to raiding capital budgets is directly contributing to that slow productivity recovery

I'm sceptical that this practice will stop, despite change in HMT regulations. We've heard that one before

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stuarthoddinott.bsky.social•58 days ago

Another point we talk about a lot: PAC argues that late agreement on ICB budgets and short term funding pots makes it very difficult for systems to prepare and plan

Completely agree that if the govt wants to improve cooperation with local govt, it needs to better align financial planning

stuarthoddinott.bsky.social•58 days ago

A point I'd add to that is that there is still a lack of capacity and capability in ICBs, partly because they're relatively new and partly because they've had management budgets cut

Along with that, they're constantly pushed on acute and elective targets and not much else. Hard to make change

stuarthoddinott.bsky.social•58 days ago

The PAC only covered it briefly, but the way financial incentives prop up the existing system is under-discussed

The govt should make much better use of financial flows to support its priorities. And to be fair it's done that a bit with the elective reform plan. But could use it for prevention

stuarthoddinott.bsky.social•58 days ago

It's a brutal assessment of the state of management of the NHS

It throws down the gauntlet for Labour. Streeting wants the system to move quickly and radically improve in 5 years. Is it possible with these barriers? How will he reform and incentivise the system to work better?

stuarthoddinott.bsky.social•58 days ago

There are also big questions for central govt:

- Can it meaningfully define prevention?
- Will it hold the line and protect capital budgets?
- Will it break the cycle of short-term funding and policy?
- Is it willing to be brave and target things other than hospital performance?

stuarthoddinott.bsky.social•58 days ago

And if you're interested in reading more about how we think the govt can make a shift to prevention in public services, you can read our report here:

https://www.instituteforgovernment.org.uk/publication/preventative-approach-public-services

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