13th April  2015

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Sir Robert Francis

In conversation with Roy Lilley

Whistle-Blowing, Complaints, the CQC and Local Guardians   

Health Chat at the King's Fund 18th May Details here

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News and Comment from Roy Lilley

If you thought the weekend was for putting yer feet up... wrong! The election spin doctors were busy talking about real doctors, nurses, midwives, care workers and NH£.


The Tories gave waved a cheque for £8bn as their contribution to the Tarzan Plan. Labour said it was an IOU and slipped out their 19 page health manifesto just in time to get tangled up with the Boat Race and the Grand National.


Labour avoided mentioning the Five Year Forward View! They said:


"Labour's plan is a better... one that will lift the service out of its current downward spiral... help put it on a sustainable footing... (to)... meet the challenges of this century as well as it did the last."


Their 'plan' is a list:


Dump the H&SCAct; cap profits of private providers; +£2.5bn to hire 36,000 more staff; reintroduce the 48hr-2-C-a-GP target; 7 day waits for cancer tests and a sinister promise to;


"... make health and wellbeing boards a vehicle for system leadership"... and "...to reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides."


In English my guess is it means; CCGs will be advisory to local government who will become the commissioners a-la Devo-Manc.


Let's look at the reality:

  • Changing targets is easy; elected Thursday, new targets by Monday.
  • Funding; dependent on new laws about taxing people who live in big houses and who live here some of the time and someplace else part of the time. Massive complexity; a year away at the very least. Then you have to collect the money in the subsequent tax year.
  • Dumping the H&SCAct means legislation, time and probably 18 months of political argy-bargy.
  • Recruiting, easy but; expanding training places will move us into the next education term cycle. And, there are fewer nurses than we thought.
  • HEE will need a bigger budget and the universities will have to find places and spaces.
  • Trust budgets will have to be expanded to hire the new staff and then there is the little matter of pensions and what-not.
  • CCGs advisory to HealthWatchers? The GPs will just love it!
  • Profit cap on the private sector? Chastened by the Circle, Serco and BUPA (and very likely Virgin) experience, the private sector won't touch the NHS with a barge-pole. Anyway, what's a profit? A good accountant will run rings around the idea.

And, there is this:


"... we will repeal the H&SCAct. This will not be another top-down reorganisation - we will work through the structures we inherit..."


'Repeal' - 'inherit' - work through the structures we will repeal? Ok, I give up.


However, this will bring a blush of cheer to the tearstained cheeks of the NHS:


"Labour's repeal Bill will legislate to ensure NHS services are fully protected from EU procurement and competition law and we will ensure the NHS is protected from TTIP..."


The Tories? We'll have a manifesto from them today? We do know they can only spend their £8bn if the economy picks up, the Euro-Zone doesn't melt and we can move off the ledge of zero inflation. Fingers crossed. And, cuts to social care are eye watering.


The political problem? The NHS eats money but as the Commonwealth Fund tells us, it is one of the most efficient in the world. It ain't perfect but what is?


Shipping it off to the private sector hasn't worked; fragmentation adds to costs, tendering adds to costs and providing services at the lowest cost in the places with the lowest price ends in tears.


And, the politicians all ignore Tarzan's elephant. Can we deliver 3% efficiencies year on year for 5 years?


I am Tarzan's biggest fan but I have to say (and someone has to); I doubt it is doable. Read Full Facts here. To get near to the old Nicholson, £20bn challenge meant 4 years of no pay increases, sacking 30k managers, screwing the tariff and using both sides of a piece of bog-roll. We can't do it twice. More for no more won't work anymore.


Let's not forget the fulcrum point; all this depends on service redesign, reorganisation and rejuvenation delivered by conflicted, confused and under resourced commissioners (whose performance has, for the most part, been underwhelming) getting their act together from the get-go.


£8bn + 3% efficiency ='s Sweating 2 Stand Still.


My guess is we are going to have to stop doing things.


Start making a list. 


Sir Robert Francis,

in conversation with Roy Lilley 

Details here 

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