The coalition continues to emphasise its ongoing support for the the big 3 – NHS, Education and the Overseas Development Fund – and yet the Chancellors mantra is a round of further expenditure cuts are required to control the growth in state debt. Something for sure has to give in this equation but where?
Nobody working in primary care doubts the need for the upgrade of the surgery network to be accelerated but the CCGs have no real vision as to where the funding flow is to be found with so many pressures on cash flow elsewhere in the service. It would not be too bad if there was light at the end of the tunnel but at the moment there is not.
We have a number of on-going development projects all of which fall in the urgent priority category and they are all held up by finance availability. A couple have only been able to move forward by squeezing size and specification sustainability would seem to be on the back burner at the moment but one can only go so far.
We hear lots of talk from economists about the need to spend on oven ready projects to get the economy working and, if the number of surgery schemes held up is anything like my judgement suggests, this would be a fantastic way to break the NHS logjam at A&E and make the very significant impact on the NHS the coalition seeks. All this with the substantial support available from the private sector through 3PD.
A few weeks ago we were taking comfort from the improving confidence in equities but once Mr Bernanke spoke about the possibility of withdrawal of the quantative easing programme sometime in 2014, the markets took fright and analysts seemed to be back in a depressive state. Today the markets are again upbeat but tomorrow, who knows? All of this uncertainty means the outlook remains very unclear and government support for its pet infrastructure projects including the big 3 remains very much in doubt.