5th August 2015

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Health Chat

Sir Robert Naylor

One of the longest serving leaders in the NHS, running one of the biggest Trusts.

What's life like at the top? Find out; in conversation with Roy Lilley; King's Fund 16th September 

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Things we have to do
News and Comment from Roy Lilley

There is an incontrovertible truth. A reality, conveniently overlooked by the NHS power brokers. They have bullied and dissembled, intimidated, terrorised and broken careers rather than admit the truth.


A truth so obvious, as George Orwell said; 'We have now sunk to a depth at which restatement of the obvious is the first duty of intelligent men'.


As David Bennett walks away from the ashes of Monitor, as if to absolve himself of responsibility for the lives of chief executives and Boards he has made a misery, he leaves behind him a silver trail of truth.


Monitor, whose job it was to set prices, tariffs, rules and balance the provider-side books admits he cannot complete his task. Four months into the year; the plans he approved are exposed as useless. The NHS is effectively broke.


In a letter, published on Monday, Bennet's best advice; 'don't spend more than you have to'. I somehow think the Boards will have already got that message.


There is more than an echo of Mid-Staffs about this mess.


Plastic Monitor, aka the TDA, have mimicked their master's voice, in a carbon copy letter to non-FTs.


Cut costs, fill only essential vacancies, ensure safe staffing guidance is adopted appropriately and proportionately. Consider the financial impact of managing waiting lists. Transfer patients to where there is capacity.


In business we would say the NHS is over-trading. A negative cycle; increase in costs, increase in debts, running out of working capital, impact on the offering and quality, loss of liquidity and bang...


In my view David Bennett has been a catastrophe for the NHS. His pricing system a catastrophe, enticing Trusts into writing undeliverable plans, a catastrophe.


Bennett's decision to increase Monitor's own spending by 12% last year, a catastrophe. Bennett has been totally humiliated by his own policies and the Monitor board, for months without a Chair, mere bystanders... a catastrophe.


Where does this leave the CQC? You tell me how it will inspect 'proportionate safe staffing'?  There is only rubbish guidance on offer and even if it was any good Trusts cannot afford to staff their Trusts adequately.  The CQC's purpose is rendered utterly futile.


If the NHS were a business it would be broke. If the NHS were a business and the Board decided to add two more, fully operation working days to their 5 day opening... men in white coats would take them away.


Bennett has one thing right. He says; "Current plans are quite simply unaffordable..."  never mind adding to the problems. 


In fairness; all he can do is write letters. For balance, I guess I should say he was dealt a bad hand but in my view, played it badly. 


I'm told there has been a huge row between Monitor and the DH.  The DH demanding the undeliverable and Monitor, nowhere near tough enough.  Monitor is an independent regulator.  The Board should have demanded a meeting with the Tinker-Man months ago and marked his card.


Bennett should have gone to Ministers and said what we all can see; 'We are heading for the edge. There is not enough money... I can't do this. I quit.' My guess; the lure of a 230k salary can induce earnings related macular degeneration.


The NHS is now plunged into chaos and the 5YFV at risk.  Provider sector deficit out of control and any deal with the Treasury at risk. 


The DH must circle the waggons before the wheels come off. Stop doing anything that isn't directly patient related. Focus on the front line.


The NHS is like a coral reef; we keep adding stuff.  We have to stop.  We need a zero-based audit of organisations. What do they do, what does it cost and do we need them.


Close the ugly sisters; the CQC and Monitor and their cousin the TDA. Scotland manages without a market. Along with that, sweep away NHS Employers, Skills for Care, commissioning support units, clinical senates, NHS 111 and OOH (let the Trusts organise it), NHSI, the Business Services Authority, the Leadership Academy.  


Get rid of every arm's length body with NHS in the title. Merge NHSE back into the DH. Strip out Healthwatch (go back to CHCs), forget Health and Well Being Boards, privatise Health Education England.


Close all the CCGs, end all contracting (like Scotland), close NICE (the Scots have a quicker drugs evaluation service, use that), break up PHE (let the MoD and the Foreign Office pay for their bits) and pay them by results.


Funnel all the money, every last pound, into what the NHS is there to do; look after patients, safely, at the front line of healthcare.


Remodel the NHS into Accountable Care Organisations. Yes, I know they are a US invention, get over it.  (More here and here). Focus activity around vertically integrated, population based capitated budgets.


Get off people's backs and free up the front line to sort its problems out and they will do smart things like this (nurses saving 150k in supplies procurement).  Small fry?  Yes, but imagine that copied across the NHS.


Business as usual is not an option.  Going out of business is not an option.  There are options;  things we'd like to do, things that are nice to do. Now is the time to concentrate on the things we have to do.



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Sir Robert Naylor
One of the longest serving CEOs of one of the
 Biggest Trusts
At the heart of strategy and policy for over 25yrs.
What does the future hold for the Vanguards, strategy, regulation, funding.
Come and hear him in conversation with Roy Lilley 
King's Fund
16th September.
Book before you go on holiday, it will be a sell out.
Acute community nurse Essex; Operations manager Surrey
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>>  I'm hearing - the mother of all rows between the DH and Monitor.
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