At weekends the Guardian newspaper cross-dresses as the Observer. Saturday evening this article appeared, via Twitter. It accuses Ministers of 'leaning on' the TDA and Monitor to delay publication of the regular financial up-sum of Trust performance. The Gobserver tells us:
"One senior figure at the health service regulator Monitor said his organisation had been "leaned on" by Whitehall to delay its report, which shows that NHS finances are worsening."
Publication of the full situation, whilst the Tories are conferencing in Fortress Manchester, would be tooooo embarrassing:
- 15 Trusts in special measures
- 71% of inspected Trusts rated requiring improvement or inadequate
- 75% of Trusts receiving bungs from the TDA to pay the wages
- Monitor rating 6% more Trusts in danger of discontinuity of service
- 33 Trust' COE posts vacant or interim.
- 2/3rds in debt of some sort.
....ouch.
It is true; biz-plans and returns were submitted a couple of months ago and should have appeared in public by now. Why not? The chair of the Health Select Committee agrees, they should be published.
My guess; if you add up all the plans and consolidate them into one set of numbers, they won't balance. The bottom line will be bigger than the top line. FTs have had two goes at this year's biz-plans and attempts to set a tariff appear run into the sand. We know the NHS is already �2bn behind the eight-ball.
The merciful departure of David Bennett, former Monitor boss, has made way for professional, portfolio, non-exec, accountant, lawyer and former NED at the Carbuncle, Ed Smith, to emerge as chair. He's been looking for a chief executive.
His choice was leaked by the Gobserver; Northumbria FT Trust boss Jim Mackey; another accountant, appointed to;
"... get (NHS) finances back in order".
I've been to Mackey's Trust. It is spectacularly good but if all Trusts were run as well as Mackey's fiefdom there still wouldn't be enough money in the kitty to run the health service. We are beyond rearranging the management deck chairs.
Geography and history have combined to put a patient and popular Mackey into an insulated position that is simply not replicated elsewhere; places where spirit, leadership and finances have been eroded by impatience, demand, time and neglect.
Mackey's well-worked, close relationship with local government (they lent him the money to buy out his PFI and fund other projects) is reflective of a collective desire for the council and health to want to do good things; rather like I reported on at Widnes.
It is rarely replicated and certainly not in the Tory Shires whose aim seems to be cut, trim, slash and close. With no one in the system with the power to make LAs do otherwise and the Better Care Fund evaporating, Mackey faces a challenge. He needs to scour the world for best practice, new ideas and different approaches. He has to show the NHS what doable-good looks like and help them do it.
Has Monitor been 'leaned-on' and is there a highly placed leak? You could be forgiven for thinking, probably and yes.
If Monitor is truly independent Smith has to rebut this, fast. At the time of writing he is still silent. If I were Smith, this Monday morning, I would start at one end of the corridor; purge, what looks like a Board, gone feral and keep going until I found the head of communications and show them the door. Then I'd talk to the press.
Smith needs a fresh start, a clean slate and to show us who's the boss.
Unless, of course, he has been leaned on? I would rather believe, for now at least, that the delay in publishing the numbers is down to the fact they don't add up. It's now Mackey's job to cajole, brow beat and bung until they do. He needs time.
Mackey must know there is no role for Monitor; packaging it with the TDA, in a 'transformation-gift-wrap' has no legal standing.
Vanguards are the future but they narrow choice and have made innovative, structural changes without market testing. Monitor will have to develop a serious case of competition-cataracts and turn a blind eye. Fine until a disgruntled private provider presses the 'it's not fair' button. Then the whole lot unravels.
In another world Smith & Mackey are authors of very good Social Psychology text books. They don't treat social psychology as intellectual candy; they give us meaty, comprehensive, and nuanced ideas.
It'll be interesting to see if S&K can rewrite the text book for health and social care (over which they have no purview) transformation.
Right now Monitor is about as useful as a sheepdog in a fish farm. Smith has a full-time job on hands and must roll up his sleeves.
