There was a time; if you asked a hospital boss what they were most worried about they would say; 'balancing the books'.
Whilst it is pretty high up on today's do-list, the truth is, the NHS is up to its armpits in debt and all the time the big Trusts are quietly reassured they are too big to fail, the NHS will push forward a bow-wave of about �830m worth of debt as it sails into the unknown.
It looks to me that they are also dragging about �2bn from last year into this year. Three fifths of Trusts are up-the-Swanny. Short of the Treasury agreeing to adjustments in Public Dividend Capital and 'writing off the debts', there is nothing much that can be done.
Top of today's worry list is staffing. There are not enough nurses. Because putative FTs cheated when they put their biz-plans together and understated the numbers they would need, so their books balanced, and government cuts in training places, we are in a mess.
As a result we are combing the world for nurses, (one in 4 come from abroad), hiring agency staff and pretending that a ratio of nurses to patients of 1:8 is safe. We are in 'something must be done' territory. What is the 'something'?
There might be a solution and I know some of you ain't gonna like it but it is practical, doable and could be in place in months.
For every nurse training place there are five applicants. There is no shortage of qualified people who want to be nurses. Nursing is a popular profession and a job for life. There is a good prospect of career progression, it is a portable skill, you can work full-time, part-time and pretty well anytime you want. Public and private.
It is stressful, challenging and difficult but it is also hugely rewarding and it comes with continuing professional development and a pension.
Even taking into account public sector pay freezes, as unfair as they might be, arguably, private sector pay has fared worse.
Unlike other degree-course students, nurses receive 'free' training. That is a huge benefit. However, it means the supply of nurses is choked-off by government's ability (willingness) to fund places and to some extent, hospitals' ability to afford to employ staff.
If nurses paid their own fees (Ouch!), like all other students, the supply-side would be freed up. Mmmm, there's a thought.
What would it mean for nurses? Huge debts? Well, no... it does not mean nurses need to stump up the cash to go to uni.
Let's look at the facts. Earn under �21k and you don't repay. Nurses start at around �21,692 so the repayments would be about �7.50 a month and you have 30 years to pay or the debt is written off. Don't work don't pay. Payments are deducted through PAYE, so there are no debt collectors.
Top end student fees are �9k but the government could argue a special case and cap nurse training fees at a lower amount. Having regard to the fact that most training modules include time on the wards, much like an apprenticeship, the fees could reflect that.
Trust employers might choose to write-off student 'debt' (as many banks, consultancies and other professions do); reflecting the fact it's cheaper than travelling halfway around the world hunting for staff. They might also play a bigger part in compiling training syllabus, responding to the changing work environment.
I know there are good arguments against this idea, just as there are against any student fees but; we are where we are.
We have; prospective student nurses denied the career opportunity they want and we give them no options; employers shelling out (collectively) millions to hire agency nurses or entice them here from Timbuktu; regulators forever kicking Trusts for not having enough nurses; and a dithering, tinkering government hiding behind HEE.
Nurses do what no one else will do, in a way that no one else can and in spite of it all there is a queue of good people who want to do it and a list of places where we want them to do it.
Maybe we have to think the unthinkable?
