NHS managers are used to abuse but Mike O’Brien’s attack is a new low

Twice in recent days health minister Mike O’Brien has threatened to publicly shame managers who “slash budgets rather than finding creative ways of releasing funds for the front line”. The message is clear: do not talk openly about cuts.

Threatening to vilify those who are making difficult decisions means managers can no longer feel they are empowered to act

Mr O’Brien is attempting to peddle a myth that up to £20bn of savings can be made without cutting services.

Of course the starting point for savings must be looking for efficiencies which improve the service to patients, such as greater use of day surgery, simplifying care pathways and moving care into the community.

But the reality is that some services will simply have to be cut. Managers from some of the best run hospitals in the country are talking about closing wards and cutting clinical staff. The government is now attempting to shift the blame for these cuts onto the managers charged with implementing them. This is akin to blaming the undertaker for the death.

Mr O’Brien’s remarks betray a worrying detachment from reality. In a speech to the Royal College of GPs he appeared to fear there are primary care trusts just waiting for the moment when they can take an axe to local services. Thankfully Mr O’Brien is on to them; their evil deeds will be exposed: “We cannot allow the economic situation to be used as justification for destroying what we have all worked so hard to build, and I will not hesitate to name and shame PCTs who view it otherwise.”

It smacks of a minister flailing around for someone to blame. In recent years NHS managers have routinely been subjected to ill-informed abuse from politicians, but to suggest someone would look for an excuse to “destroy” services is a new low.

Such pre-election posturing might easily be dismissed. But there is a risk Mr O’Brien’s outbursts will make the impact of the cuts more severe.

In May NHS chief executive David Nicholson put the interests of patients before those of politicians by revealing the service would need to save £15bn-£20bn between 2011 and 2014.

The aim was clear - give the NHS as much time as possible to make the right savings in the right way, using efficiency to drive quality while minimising the need to simply close services.

A few weeks later the NHS Confederation conference was buzzing with talk of how to get the service in the right shape, with open discussion about what needed to be done.

Mr O’Brien is attempting to crush that. Threatening to vilify those who are making difficult decisions means managers can no longer feel they are empowered to act. This is a recipe for paralysis; tough choices will be delayed or ducked. Managers, particularly commissioners, will be tempted to keep their heads down to avoid having them shot off in the election crossfire. Precious months will be lost.

This direct ministerial intervention in local decision making makes a nonsense of Mr O’Brien’s claim on Monday in a written parliamentary answer that “the provision and development of local health services and facilities are the responsibility of the local national health service”.

Bullying and threats will only make it more difficult for the NHS to find a route through the public spending squeeze. The way to avoid macho “slash and burn” cuts is for trusts and PCTs to collaborate on finding improvements where possible, cuts where necessary. Community services must play their part - the burden cannot just fall on hospitals. And clinicians need to be at the centre of discussions, taking ownership of the problem and using their insight and knowledge to find the best solutions.

All that takes time, which means working through the options now, not putting off the inevitable until after the election to avoid embarrassing the government.