“And NHS professionals are not going to aim to underspend are they a sthey might get less next year- it's always better to overspend in the hope that they will be able to make a case for more money next year.”
Yes, the common strategy of all government departments and local authorities. Businesses build their budgets going forward. They forecast what they might be doing and cost their plans accordingly. Public bodies do the reverse. They look at what they spent last year, add 2x% to it for “luck” (knowing they will only get x%) and that’s their bid.
I have a relative who worked for a local authority. Every year around the beginning of March he and his colleagues had gifts bestowed upon them by their employer. One year he received a new laptop “in case he was required to work from home”. He never was and the laptop remains in his possession to this day, long after he left the job. Another year he received a new outdoor coat and protective boots “should he need to go on a site visit”. He had not and never did leave his office on business. The reason for this largesse with taxpayers’ cash was that if the money was not spent less would be provided the following year. There was no notion whatsoever that If it wasn’t needed it should not be part of the bid.
In common with most other government departments the NHS will never have enough money available. In the early 1960s government spending was, in real terms, about a quarter of that squandered today. As I recall nobody was suffering “catastrophic cuts”, there were not wholesale deaths of people dying from starvation and women did not need “free” sanitary products.
Many of the problems faced by the NHS could be cured at little or no cost whatsoever if only it was managed properly and, most importantly, if it was removed from the control of politicians who use it as a point-scoring machine against their opponents. But it won’t be and its problems will exacerbate until it becomes so inefficient and unwieldy that it will collapse. It is as safe with a Tory government as it would be with any other - that is, not very safe at all unless it is drastically overhauled.