The NHS: Where does all the money go?
Part 7a: Department of Health and Social Security (DHSC)
Body name: Department of Health and Social Security (DHSC)
Place in the wiring diagram: National Body
The body's stated function is “We support ministers in leading the nation’s health and social care to help people live more independent, healthier lives for longer. DHSC is a ministerial department, supported by 23 agencies and public bodies.”
Its budget: The wiring diagram we reproduced in Part 1 of the series reports the budget as follows:
Number of Staff
Full-time staff reduced from 18,000 at the peak of the pandemic to below 6,700,
Grey areas:
The wiring diagram we reproduced in Part 1 of the series reports the organisation. Both diagrams of the English NHS were as reported by Parliament.
So, organisation and funding are in reverse order here. For Part 1, see:
To try and work out what is going on, we went to the massive Department of Health and Social Care Annual Report and Accounts 2022-23 (The period ended 31 March 2023).
We got no further than page 5 and got stuck in what must be the consequences of two old, medically trained geezers with a combined IQ of 3—yet another organigram. How many are there, we ask, and which one is the right one?
For starters, we’ll have to investigate the spending on 42 Integrated Care Systems (see page 32), or integrated Boards as in the diagram, and the 23 agencies and other bodies supporting the DHSC.
Ah, pure semantics, Sir Humphery would say. Second, the budgets from the first picture (main funding flows) and Figure 1 below from page 5 differ. For example, look at NHS England: £153 billion in the first diagram and £159.1 billion in Figure 1 (from page 5 of the reports above). Okay, so what's a few billion among friends?
We are also increasingly confused about who is in charge of what. For example, the DHSC says its priority is protecting public health through the health and social care system’s response to COVID-19, yet this is the mission of the UKHSA.
We weren't aware of the COVID-19 Battle Plan launched in 2020 as a Department’s programme. It seems the DHSC was at war. We are also confused about how the DHSC considers it delivers on its strategic priority (see page 8) to improve healthcare outcomes by providing high-quality care when over 7.5 million people are on the waiting list.
As the figure suggests, DHSC costs £3.3 billion to deliver what TTE considers - on initial review - is for duplication of other services.
Recommendations
Sharp-eyed readers will go cross-eyed trying to balance the two diagrams, tables, or what have you. We apologise but can’t help you, as we do not have two thousand quid for luxury eyewear to offer you. We will try to disentangle the 348 pager from the DHSC for you, but our confidence is rapidly sinking after stalling at just page 5. To cheer you up, we want to know whether you can spot anything else in this forest of wires, boxes, and arrows.
Go on, try it.
Two old geezer taxpayers wrote this post, and we could do with more eyeballs and luxury eyewear to inspect the sheer number of reports and accounts the NHS produces in one year. Oh, if only we were accountants or had a friendly Lord on board.
Speaking of eyewear I would be interested to know Sir Starmer's prescription . My suspicion is that he has reading glasses to manage his presbyopia. I bought some very satisfactory ones for £11.99 (3 pairs). After a year I am still on the first pair. I paid for them myself.
It appears to me that of the entire NHS budget, less than 2/3 is used to treat patients directly. This is utterly ridiculous, there are far too many hangers on, and not enough medical staff who face patients. Keep asking questions, and please report the answers to Nigel Farage and Reform directly. There will be some interesting debates and questions in Parliament for us to watch, at least we will get something for all our money! In addition Stalins glasses look virtually clear to me, are they another theatrical prop?