12th May 2015

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Dr Mark Porter

In conversation with Roy Lilley

Chair of the BMA - just how relevant is the BMA; does anyone listen to them?

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

It's a deal
News and Comment from Roy Lilley

You have to go back to 1640 to make sense of the name Streynsham. Son of the deputy-lieutenant of Dover Castle, East India Company and all that. You'd have to have a peculiar reason to call your son Streynsham, wouldn't you? A family name, to be sure.


Jeremy Richard Streynsham Hunt... ring a bell? Who better to be reappointed SoS Health. Known to us all as; LaLite. There is an interesting genealogy here.


So, here we are again. Ground hog day? Been here before, got the T-shirt? Not quite.


Last time around it became clear, even to Blind Pugh, that Lansley's reforms were unworkable, toxic and just plain barmy. It was the NHS's own fault they got any traction. If the organisations that charge a fortune to represent the various factions, vocations and groups that work in health, had stuck together and said 'stuff the reforms', Cameron would have been well and truly... stuffed.  


A bewildered Steve Field fudged, fiddled and soft-shoe-shuffled through Cameron's pause and made a hopeless mess of it. Surgeons liked the 49% bribe, raising the private practice threshold. The BMA were seduced and flatered into believing GPs would (and could) run commissioning. The rest were too shell-shocked, too busy with the day job, or too polite to do the stuffing thing.


The Trades Unions were dismissed as being ... well, trades unions. The King's Fund danced around its handbag, the think-tanks stopped thinking and the affinity groups were too desperate to stay in the tent to say anything thing that might get them kicked out of the tent.


MPs didn't understand it; Shirley Williams bottled it and frankly Clegg covered up about his real intentions to break up the NHS. Not to put too fine a point on it; it was a bloody awful mess. Lansley dug a deeper hole, got the sack and Streynsham arrived.


He told us the NHS was coasting - that didn't work. He schmoozed and no one trusted him. In the end bungs and bullying saw him though, thrown a lifeline in the dying minutes of his term; the 5YFV.


Like a drowning man grabs at nearby flotsam Streynsham seized the idea that trading 22bn of NHS efficiency savings for 8bn in taxes was a good idea. Actually it was a bargain. It also meant (assuming the polls were right) he didn't have to write a health manifesto with anything that couldn't be traded into oblivion with the Lib-Dems. He didn't even have to say where the 8bn was coming from.


Where could it possibly go wrong? We now know! The polls were junk. So what happens next? Streynsham is on his own and has to deliver.


It is impossible;

  • You can't manipulate flow through the system, to envisage 24-7 working in the midst of a workforce and funding crisis.
  • The majority of GPs are just not interested in longer opening and there are not enough of them, even if they were.
  • Parity of MH provision is out of the question.  MH budgets are being cut; to borrow a well-worn phrase, 'there isn't any money'.  
  • Thinking nice things about cancer and dementia will stay 'nice things to think about'.

Inspection hasn't improved quality of services, markets haven't made the NHS any smarter, slicker or quicker, the NHS is probably insolvent and Streynsham has to pretend the H&SCAct never happened. It is unworkable.


What to do? Be radical, just like the original Streynsham. In 1681 he cleaned up the East India Company by a combination of trust, transparency, improving the lives of the workers, justice and respect.


I think there are enough fabulous people in the NHS who know what to do. He just has to have some respect, listen and create the time and space for good people to do great things.


If he abandoned 'control' and optimised the NHS around experimentation I am sure the discoveries will surprise him. Allowing people and health economies to discover what is right for them and get on with it.


Move the NHS from top down, to mutuality; where people could benefit from interdependence and working together in the pursuit of excellence.


Streynsham must come clean. There isn't any money; doing more for no more is no longer viable. He needs to strike a deal; 'I'll keep everyone off your backs if you back me and together we deliver world-class.'


I think the NHS would say; 'It's a deal'.


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