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Editor's blog 22nd October 2008: finance and up-coding

A beautiful, crisp and clear good morning to you. Two quick pieces of note today: an excellent piece in The Independent reports on Norwich Union's investigating fraud in claims from clinicians.

One consultant gastroenerologist's private work saw £85,000 of fraudulent claims. Another particularly optimistic gynaecologist claimed for work done on pars of a patient's anatomy that had already been surgically excised.

The report claims that it's costing tens of millions of pounds in the fairly tiny private insurance market. So what do we think it might be in the NHS? Commissioning certainly has its work cut out.

Meanwhile, the ever-reliable Nick Timmins in the ever-reliable Financial Times rightly warns that the financial pain, be it in tax rises or real-terms public spending cuts, will not arrive before 2010.

As Timmins previously reported, the NHS management board meeting last Friday delayed the publication of PCT allocations and of the revised tariff. These are likely to come after next month's pre-Budget report from Chancellor Darling. Timmins reports that NHS chief executive David Nicholson told the board they must plan over a five-year spending period, as opposed to the remaining two of the current Comprehensive Spending Review.

Meanwhile, Lord Mandelson told The Andrew Marr Show that he wanted the public sector to pay small and medium-sized enterprises within 10 working days. No definition of medium-size, unfortunately, but this could be an interesting cultural precedent, which may reverberate widely in the NHS.

What does all this mean?

Well at one level, it's difficult to see how you plan for five years when the allocation and tariff are on hold. Health Secretary Alan Johnson repeatedly promised the NHS Alliance conference last week that he would not re-open negotiations on the CSR settlement for health. This was a bold response, and means one of two things.

Either Johnson has cast-iron assurances (or perhaps incriminating photos) such that Financial Master Of The Universe PM Brown and Chancellor Darling mean what they have publicly said about the 09-10 and 10-11 spendng increases for health being in the bag.

Or that ex-trades unionist Johnson will not be re-opening the spending negotiations on NHS pay because if it comes to that, he will go - and so somebody else will reopen them instead.