27th March 2015

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Dame Julie Mellor, Parliamentary and Health Service Ombudsman in conversation with Roy Lilley

King's Fund 15th April Details here

Give it back to the NHS
News and Comment from Roy Lilley

Last year I chaired People's Inquiry into healthcare in London. We made 18 recommendations, some dire predictions and as is usual with these things, the world moved on.


Yesterday, the King's Fund published a report on healthcare in England. The King's Fund pretty well mirrored what we said last year; running our of steam, not enough money, too many patients, no strategic grip, dive in performance ... blah, blah.


Since last year my group have moved on. Yesterday we published 'London's NHS, Into the Unknown', an update on our first report. Guess what? We think things have got worse; on its knees, nowhere near enough money, far too many patients, absolutely no strategic grip, plunge in performance... blah, blah.


We added the plight of the London Ambulance Service, presently hunting down paramedics in the Australian outback and HealthWatch that seems to have fizzled out. We think a return of Community Health Councils might be better.


I am under no illusions; as clever as the King's Fund report may be and as detailed as our report might be, both reports will be side-lined. I expect the voice of the Tory Party (aka the DH press office) are already thinking up soppy things to say.


What strikes me about all this is, as the election nudges closer, two quite different, independent groups can arrive at almost identical conclusions and the politicians are overcome with agraphia and dyslexia. Or, is it, maybe, they just don't want to know.


With six weeks to go before the election I have no idea what the main political parties are going to 'do' about the NHS'.


Labour published a complicated 'whole person/centred' thing that made Andrew Lansley's ideas look like Janet & John and promised to lob-in more money than the Tories.  Unfortunately they can't do that until 2017 because they first have to organise their Mansion Tax and other stuff to pay for it.


The Tories have left the NHS out of the Cameron 6 priorities and are promising to make a down-payment on Tarzan's 5YFV and ring-fence the Service.


It's the same as the Coalition are doing now.  Meaning; under 1% per annum more cash, against 4% growth in demand. Do the maths... they've hobbled the NHS and more of the same will cripple it.


The rest of the political parties (who might hold the balance of power) are trying to butter my parsnips; especially the Lib-Dems. They are promising the 8bn Tarzan says he needs to make his Plan A work.


However, Plan A comes with eye watering, never achieved before, yer-avin-a-larf, 3% savings from efficiency, modernisation, moving hospitals into GP surgeries, telemedicine and self-care including helpful web-based instructions for DIY cardiothoracic bypass surgery on the kitchen table. There is no Plan B.


May I suggest someone in politics might like to think about; 'more doctors and nurses' doesn't mean 'enough' docs and nurses. How many do we need and how much? Does anyone know? 


Locum and agency bills are melting the NHS' credit card. Oh and Social Services have neither the staff nor the money to keep people out of hospital nor get them home safely. The Better Care Fund robs Doctor Peter to pay Social Worker Paul.


Tarzan plans to sell-off 7.5bn of surplus land. A fire-sale will drive prices down, capital can't be turned into revenue and be careful what you sell, you can only do it once. Being a landlord might make more money.


Reducing the agency budget and converting temporary employment to permanent will require an enforceable ceiling on agency costs and a more flexible approach to how the NHS employs its (mainly female) workforce.


Dumping management consultants is only a good idea if the NHS has the skills, experience and capacity to do its own thinking. Billions were spent sacking and redundanting 30k managers and waving their knowledge-legacy goodbye.


Greater use of IT could ameliorate rising costs but that requires investment and root-and-branch changes in the way the NHS works. All these great ideas might come good over ten years.


'Things to do now', that's the issue. The NHS needs headroom, space and a few quid to make new stuff happen. Right now the NHS is running up the down escalator putting on its lipstick.


It seems to me; if the Chancellor can take a 1p off a pint he could give it back to the NHS.


Have a good weekend. 


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Dame Julie Mellor
Parliamentary & Health Service Ombudsman
In conversation with
Roy Lilley
Just what impact has the PHSO had on better care?
15th April 2015
King's Fund
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>>  I'm hearing - someone has worked out it will take 3.5 years for the CQC to inspect all social care places, 10 years for all Trusts and 4 1/2 years for primary care.  And then they have to start again.  Will someone in Whitehall, with a bit of a brain, realise inspection does not deliver better quality anything, never mind care. This is from a comment on the HSJ pages:
Compare 2007 with 2015;
Excellent/Outstanding - down from 13% to 1%
Require improvement or only Adequate up from 24% to 30%
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>>  I'm hearing - nothing about the Community Nurse Development programme; is it dead?.
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