Between a rock and a hard place?

If the results of our latest Health Leaders’ Panel survey are anything to go by, senior managers are facing uncomfortable times at the moment.

Blog post

Published: 25/09/2015

If the results of our latest Health Leaders’ Panel survey are anything to go by, senior managers are facing uncomfortable times at the moment.

Members of our panel - which comprises senior managers and clinicians from the acute, mental health, community, primary care, commissioning, social care and independent sectors, as well as representatives from local Healthwatch bodies - told us that the scale of savings expected of their local health services in order to generate their share of the £22bn efficiencies required of the NHS were “unprecedented”. 

Sixty-seven per cent of our panellists were not confident that credible plans were in place locally to achieve required efficiency savings this year, and 60 per cent of respondents were unconvinced about the credibility of their local five-year plans. One said simply: “We do have a plan and it is very innovative. But, it won’t save the money that is required.”

A significant majority of respondents (83 per cent) agreed with former NHS England chief executive Sir David Nicholson’s recent comments that the financial pressures could mean “managed decline” for the NHS and only 15 per cent thought it feasible that their local provider would stay in budget this year. Just over half (52.7 per cent) thought that adhering to targets and guidelines was causing organisations to compromise on quality elsewhere.

Nevertheless, the panel was almost united over the issue of urgent seven-day services, with 96 per cent of respondents saying that implementing improved urgent seven-day services in line with the NHS England clinical standards should be a high or moderate priority. But accompanying comments revealed concerns over whether this was affordable - one respondent said: “The current proposals will require significant additional investment and unless the core service is properly funded there is no point in making the current financial situation any worse.”

These competing challenges point to the fact that health leaders are having to manage a significant amount of cognitive dissonance. It is difficult to see how it will be possible to implement large-scale service improvements while also achieving substantial efficiency savings. As we and the other health think tanks have made clear in our submissions to the Spending Review, the unfolding financial picture doesn’t look promising at all for the provider sector. 

One panellist, who is very confident in their area’s five-year plan, knows this. They warn that implementing the plan comes at “too high a price to pay” - with threats to prevention, rehabilitation, specialist housing, seven-day services, quality personal budgets, and out-of-hours access to mental health and drug and alcohol services. So does a panellist who is not at all confident about their five-year plan, pointing out that “the size of the problem requires change on a scale that appears to be politically unacceptable". 

The ability of the government and the NHS to resolve some of this dissonance would appear to be critical to the NHS’s ability to keep a grip on its finances and work out which services it should be prioritising in the short term. At the moment, the lack of progress in this regard is worrying. 

Suggested citation

Crump H (2015) ‘Between a rock and a hard place?’. Nuffield Trust comment, 25 September 2015.