The election has turned into a bidding war. We could forget about polling stations and do it all on E-Bay;

"I'll bid 20,000 nurses..."

"Oh, then I'll bid 20,500 nurses and a hundred doctors".

"Right; I'll up-you with 20,500 nurses and hundred doctors and 7-day opening..."

In the meantime hospitals struggle on (Excellent HSJ Exclusive) with standards they have no hope of meeting.  Gimmestrenght.

I get no inkling as to where the new recruits will come from and HEE's capacity and budget and the universities and the need for expansion, lecturers, placements and accommodation. And, the money to pay for it all and the money to employ them all. And; �8bn won't get near funding any of this. The NHS needs �8bn to keep the lights on.

Dig a bit deeper into the manifestos and the issues of contracting, denationalisation and privatisation are of more serious import.

The Tories have airbrushed the Health and Social Care Act out of their manifesto. In reality LaLite has been running the NHS with complete disregard to the tenets of the Act. Monitor has been put in a box; integration is the new black. If the Tories win or cobble together a rag-bag coalition, what happens next? I have no idea but like you, I can guess.

Labour? If they can juggle the SNP and get across the line, they say they will unpick the H&SCAct, strip out the tendering bit, dump Part lll (the Monitor bit) and proclaim the NHS its own preferred provider.

Labour seem to be saying they will repeal the entire H&SCAct and then, confusingly, go on to say they will avoid disruptive, top-down reorganisations and 'work through existing structures'... presumably the ones they have 'repealed'?  It makes no sense to me...

Can Labour dump the market? Well, the Spanish did. They now operate on the basis of 'solidarity'... just like Scotland and Wales.

What would it take? Almost certainly abolishing Foundation Trusts who are semidetached from the NHS. They would have to be brought back into the 'family'.

Whilst the parlous state of NHS finances means there are slim pickings for the private sector, Circle, Serco, BUPA, gone and few other entries on the horizon, Virgin remain one of the biggest providers of community services. Presumably their contracts would be left to fizzle out and the staff brought back into the NHS?

What happens to GPs, pharmacists and dentists (all private sector contractors) is anyone's guess. The whole CCG structure is predicated on contracting and competition; with Monitor ready to mug them, they struggle to be collegiate and arrange integrated care. Merging CCGs with Health and Wellbeing Boards might be a quick, whole system solution or just add to the confusion.

What happens to contracts with the likes of Weight-Watchers, Macmillan, Terrence Higgins Trust and all the others? Hospices? Dunno? Just like you can't be a little bit pregnant; you can't be a little bit of a marketer.  What is it all worth and just how much of a Gordian knot is it? We can try and find out.

In an overlooked report from the Centre for Health and Public Interest we get a feel for what a mess this is.

• One fifth of the NHS budget is contracted out but that includes GPs, pharmacies, opticians and dentists.

• In the last four years there has been just under a 50% increase in the amount spent in the 'real' private sector by local commissioning bodies and NHS trusts; �6.6bn in '09 to �10bn in '14.

• CHPI estimates there are about 53,000 contracts between the NHS and the private sector.

• The contracts are sorted, selected and supervised by 25,000 staff working in CCGs, CSUs and LATs... at an annual cost of �1.5bn.

• Commissioners have nothing like the firepower they need to ensure contract compliance and with patient facing services the only hope is the CQC can plod around in time to pick up the debris. (More from the Indy)

• There are almost no public records of contract compliance visits from the CCGs.

It gets worse. Apparently, the Carbuncle is planning to outsource contract compliance to CSUs who after being emasculated are headed for the private sector. All told there is �10bn in commissioning contract value at stake and it looks to me like no one is on top of this.

Yes, I know... this is no way to run a business.... nor a public service.

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Sir Robert Francis,

in conversation with Roy Lilley 

Details here 

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