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Who ate all the pie? The NHS

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While watching the manifestos appear, promises made and a new government elected, the NHS carried on and made the arrangements for this year.  Activity plans have been agreed, tariffs applied and commitments made to the better care fund in a joined-up and integrated fashion.  

As a clinical commissioning group our plans have been scrutinised and assured by NHS England. Have we put up the wherewithal and certainty for our providers so that any waiting lists for operations will evaporate away like an autumn frost and for A&E to flow smoothly in winter?  

These targets, 18 weeks from referral to treatment (RTT) and no more than a four-hour wait in A&E are a big deal for patients and – crucially – for the NHS in its relationship with ministers.

The NHS is not a single mind. Budgetary control squares off against delivery of agreed standards, just as it does across all of government and public services. In the past few weeks within the commissioning silo, it has felt as if affordability may not be an excuse for failing to commission sufficient capacity.  

A personal view is that positions are already being taken for the difficult conversations that will come later on this year. If the target is missed at a national level, commissioning High Command wants to be able to say that enough capacity was commissioned, it foresaw the right levels of demand and that the fault must be with providers.

Locally, I think we need to keep seeing this as a problem that all cogs in the local machine share to provide a sustainable way to care for patients and residents.

Personally, this is to do with answering the question, ‘who ate all the pies?’. For council colleagues and across government the answer is ‘the NHS has’.

For the NHS to have been protected, but to have failed to meet the core targets in its constitution, when others seem to keep the lights on at least, is a tricky spot to be in.

Much of the campaigning before the election was about protecting and improving the NHS: we should expect greater and greater scrutiny on whether this financial protection actually translates into protecting and improving standards of care for patients and residents.

Rich Hornby, chief financial officer, Coastal West Sussex Clinical Commissioning Group, writing in a personal capacity


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