stuarthoddinott.bsky.social
Senior researcher in the public services team
@InstituteforGov. Interested in the NHS, adult social care, and local government. All views my own. He/him
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The quote comes from Nick Timmins' paper last year
I also love this quote: "What the Treasury mistakes for financial control is spending money in small packets"
www.instituteforgovernment.org.uk/publication/...
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To be clear: I think there is definitely a need for more management and analytical capacity in the NHS. I just think it should be closer to the frontline - ICBs, trusts, PCNs etc - and not so much in the centre
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What a weird coincidence that only one person out of all NHSE leaders is named and judged "likely to remain in her post"
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And higher spending on public services e.g more demand for acute children’s services, more SEND need, worse health outcomes
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This is all in the form of "capitalisation directions" i.e. allowing local authorities to sell assets or borrow to fund day to day spending - usually forbidden
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There is a slight difference this year though: the govt has stopped LAs from selling "community and heritage assets"
The govt also granted 6 LAs the power to raise council tax by more than the limit for other LAs - all 6 of those also receive EFS
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Source is here: questions-statements.parliament.uk/written-stat...
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In a narrow sense, the PH grant is ringfenced in local govt. Without that, I think it would have been raided more in recent years. So that's positive
But I agree (and have argued) that govt should do more to define which spending it considers preventative and then look to protect those programmes
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Central govt should set out its priorities, provide a stable policy and funding environment, create the incentives to drive desired activity (targets, funding flows etc), and *then* get out the way to let local systems work out how to achieve priorities
Or something, slightly half-formed thoughts
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I agree that there's been too much tinkering over the last few years, partly because of political chaos. The system would benefit from policy and funding stability
But I also think the status quo is broken. "Getting on with it" = more hospital funding and activity, which isn't working
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Fully with you on this. NHSE and DHSC massively undervalue GP services imo
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I completely agree with you, far more bang for HMT buck from investment in public health imo
I think the difficulty is incentives deprioritise public health investment at the moment and NHSE/DHSC don't seem willing to change, as PAC argue
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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:
www.instituteforgovernment.org.uk/publication/...
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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?
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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?
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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
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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
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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