The NHS is facing a “substantial financial problem” which politicians are ignoring in the election campaign, the former head of the service says.
Sir David Nicholson, who retired last year, told the BBC the NHS in England was accruing large deficits which would become “crystal clear” later this year.
But he said instead of talking about how to address these, politicians were focusing on expanding services.
He said the situation caused him “very great concern”.
In an interview for BBC Radio 4’s Today programme, Sir David – who ran the NHS in England for eight years – said that because there was an election period, the NHS was unable to publish the latest report on its financial position.
But he said it was “pretty clear in the NHS that there is a substantial financial problem, particularly in the hospital sector” which would become “crystal clear” in the autumn.
Policy guide: Health and care
This issue includes NHS funding, GP access and social care, particularly of older people.
Sir David predicted the scale of the problem would be bigger than the one he inherited in 2006 on becoming NHS chief executive, when the health service had accrued a £1bn deficit.
“I have not heard in most of the conversations politicians are having at the moment about what they’re going to do about that financial hole.
“They want to talk about extra services and extra investment when actually there is a problem there to face.”
He said the NHS would have to take “emergency action” such as vacancy freezes.
But he added: “It will also mean the politicians having to suspend some of their ambitions about the new things they want to do while some of the money that’s being promised to the NHS is spent dealing with that particular operational problem.”
Who is Sir David?
- Sir David Nicholson spent more than 30 years working in the health service.
- His first chief executive post was in 1988 when he became boss of Doncaster and Montagu Hospital Trust.
- In the late 1990s he moved into regional NHS management, becoming head of the Birmingham and Black Country health authority in 2003.
- Two years later he also took charge of two neighbouring organisations, including the one that oversaw Stafford Hospital, after the decision was taken to merge health authorities.
- He then became chief executive of London’s health authority in April 2006, but within months took over from Lord Crisp to run the whole health service – a job he held until last April.
- He now advises governments across the world about health care.
Sir David also said the financial problems were going to be there for the medium term.
Last autumn Sir David’s successor Simon Stevens set out a five-year plan for the NHS in which he said the health service would need an extra £8bn by 2020 – something the Conservatives and Liberal Democrats have committed to in this campaign.
That was on the basis that the NHS could make £22bn of efficiency savings.
But Sir David said it was a “very tough ask” as the NHS had already made much of the savings it could through steps such as restricting pay awards and reducing management costs.
He said that meant that in the future the savings would need to come from “changing the way we deliver services”.
“That is very hard in terms of making it happen and explaining the arguments around it.”
He said if the savings were not made, it would lead to what he called a “managed decline”, which would involve patients waiting longer for treatment, new drugs not being made available straight away and it becoming more difficult to see a GP.
Anita Charlesworth, chief economist at the Health Foundation, said she agreed with Sir David.
She said: “NHS finances can only be described as dire at the moment, three quarters of our hospitals can’t balance their books and at the turn of the year they were running a deficit of £900m.
“The outlook in the medium term is also really challenging, [the NHS] needs extra funding each and every year.”
Sir David also defended his role over the Stafford Hospital scandal. He spent 10 months in charge of the local health authority in 2005 and 2006 at the height of the problems and soon after that was appointed NHS chief executive. This involvement led to campaigners and MPs to call for his resignation.
Sir David told the BBC: “Other people will make judgements about my record. I think I made a contribution to improving services. But obviously I regret people suffered. I regret patients did not get the best possible care.”