‘The money is a f**king nightmare’, says NHS England chief executive

The NHS England chief executive was speaking to a briefing for senior trust and integrated care system leaders in London yesterday, which outlined the current challenges facing the service, and how they should be tackled. HSJ has spoken to multiple people who were at the meeting. 

NHSE publicly raised concerns last week about the impact of inflation on spending, saying costs could rise by £7bn next year and that without additional government funding, services may have to be cut and investment curtailed.

The national body had earlier warned about the impact the £2bn unfunded element of the NHS pay deal would create, as well as the challenge of delivering the £12bn “efficiency” programme agreed with government over the next three years.

According to multiple sources, Ms Pritchard told yesterday’s meeting “the money is a f**king nightmare”. But she stressed that it was a “nightmare” which the NHSE leadership would try and deal with, and that local chiefs should not be distracted from seeking improvements because of it.

She also told them “we must not collude with defeatism” which the multiple pressures facing the system might engender. She urged local chiefs to seek out “marginal gains” from improvement programmes - as this could have a significant effect on NHS performance pressures despite the financial squeeze.

One local CEO described it as a “brave and impassioned speech” and sensed frustration from Ms Pritchard around the issues of health inequalities and prevention. 

According to HSJ’s sources, Ms Pritchard said inequality and prevention are no longer spoken of by government ministers, but that the NHS could and should continue to prioritise efforts in those areas.

It was reported earlier this week that health and social care secretary Therese Coffey intended to drop a scheduled action plan to tackle smoking in England, while prime minister Liz Truss recently ordered a review of the government’s anti-obesity strategy. The health secretary has said her four priorities are ambulances, backlogs, care and “doctors and dentists”.

Another source said: “She and Julian Kelly are clearly wrestling with government at the moment and I really got a strong sense that she’s in our corner, fighting to do everything possible to help make our services better.”

A public board report authored by NHSE finance director Julian Kelly and published last week showed NHSE’s revenue budget for 2022-23 falling in real terms by 1.4 per cent compared to last year, as money supplied to help the service cope with the pandemic was withdrawn. This was despite the daily average of covid-positive patients in hospitals being higher so far this year than last year.