Surplus 'fantastic opportunity'

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Adam Brimelow Health correspondent, BBC News Cornish teenagers are healthier after joining a dance club

Government borrowing is at record levels and bailing out the banks has put yet more pressure on public finances.

Yet the NHS in England is set to run up a substantial surplus, for the second year running.

Public health campaigners say it represents a fantastic opportunity for the health service to invest in innovative services to improve health.

One example of where money may be well spent is a weekly afterschool dance club for teenagers in the Cornish town of Camborne.

Called TR14 after the local postcode, it has no funding from the NHS, but in the three years the project has transformed the health of local children from deeply deprived backgrounds who get to try out new dance-moves and routines and to plan shows and training workshops.

I started eating a lot more healthily and now I feel like I'm more alive Jody Baxter

Many have stopped smoking and binge-drinking, their diets have improved, crime and anti-social behaviour are down, and they're doing better at school.

"Before Tr14ers I used to be one of the rebels that was out on the street, drinking all the time.

"And it made me feel that I'd hit rock bottom always having hangovers," says 17 year-old Jody Baxter.

"But then when I started dancing I got into the more healthy side of stuff.

"I started eating a lot more healthily and now I feel like I'm more alive."

Michael Opie, who's 19, agrees. "Before I was asthmatic. I rarely did any exercise whatsoever.

"I just stayed at home but now I'm just constantly wanting to dance, to go out and do stuff.

"It's given me great confidence as well."

Goodwill

The scheme relies on local goodwill, but like so many projects of this kind, it's in financial crisis.

Professor Richard Parish from the Royal Society for Public Health said: "This is just the sort of programme that we ought to be investing in.

"The amount of money needed to support initiatives of this kind is really tiny so there's a real opportunity with the underspend to spread this right across the country.

"And my organisation would be very happy to work with the Department of Health, and the Tr14ers and similar projects to try and make sure we absolutely mainstream this over the next few years."

Elsewhere in the health service there's no shortage of ideas about where the surplus should go.

The British Medical Association suggests putting it into what it calls neglected specialties, including elderly care, pain medicine and mental health.

Then there's the target for maternity services.

From the end of next year all pregnant women in England should have the option of a home birth.

All of us want to see these surpluses that you've worked so hard to build up used to best effect, and not just regarded as a problem Bill Moyes, Monitor

Louise Silverton from the Royal College of Midwives says staff shortages and the rising birth rate are putting this in peril.

"Currently very few units are able to offer the full promise, and we believe that without significant investment in maternity services the government is going to fall well short of this welcome promise."

On top of the NHS surplus, foundation trusts are sitting on a further £350m.

Innovation

Bill Moyes, the executive chairman of Monitor which regulates these trusts, says they have more freedom to innovate and invest, and that's what they must do.

He advised them to be proactive and work closely with Primary Care Trusts to work out where the investment should go.

"All of us want to see these surpluses that you've worked so hard to build up used to best effect, and not just regarded as a problem."

The department of health in England insists that the current levels of surplus are consistent with sensible budgetary planning, and a lot of NHS managers agree.

It allows us to invest in completely new ways of doing things in the future Trevor Campbell Davis, Oxford Radcliffe hospitals NHS trust

After years of deficits, the Oxford Radcliffe hospitals NHS trust is now making a small profit.

The chief executive, Trevor Campbell Davis says this is good housekeeping.

"As well as looking after our buildings and our staff, we're beginning to look at new treatments, and at research because of course we're a university hospital in Oxford.

"It allows us to invest in completely new ways of doing things in the future.

"We couldn't do that if we didn't have a good balance sheet."

And there's every expectation that those health service balance sheets will come under renewed strain.

There's growing pressure on pay, the relentless drive to improve care, and then there are long-term challenges such as obesity the ageing population.

Dealing with these won't come cheap.

So while there's little consensus on how to use the NHS surplus, any attempt by ministers to claw it back would meet fierce resistance.