Thread by @HMAnderson39

A quick thread on some of the finance-related points about the Darzi review. It's a brutal assessment of where things have gone wrong.

First off, NHS is a major outlier on clinical negligence - well above comparable countries like New Zealand, Canada and Australia.

This was pretty shocking:

Since 2006 NHS leaders and politicians have promised to shift money out of hospitals - in fact, the opposite has happened and we're now spending more on hospitals.

"The NHS has implemented the inverse of its stated strategy"

Darzi is excoriating on the lack of capital investment - if the UK had kept up with other countries it would have invested an extra £37bn.

"The capital approvals process is so byzantine that it is hard to find an NHS senior manager who understands it. It has left much of the NHS crumbling".

Darzi also criticises the routine practice of using the NHS capital budget as a "informal reserve to protect against NHS deficits"

Chart below doesn't cover last yr's raids of nearly £1bn

Interestingly, the review also criticises the move away from payment by activity (which the NHS leadership has wanted to do).

Will NHSE bring back payment by activity for emergency care?

and finally - this is remarkably measured, given the language elsewhere - hospitals in deficit "may begin to believe they will always be bailed out"

Some trust CEOs would say we've already reached that point...