9th November 2015

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Health Chat

1st December King's Fund 5.30pm

Janet Davis - New CEO and Gen Sec of the RCN

What is the future for nursing?

Tickets here.

RCN concession.

News and Comment from Roy Lilley
Squaring the circle. A simple problem of geometry from the Greeks; construct a square, with the same area as a given circle, by using only a finite number of steps, a compass and straightedge.
Off you go. It'll drive to barmy by lunchtime and you'll be out of it by tea time and gone by bed-time.
Linderman-Weierstrass, the Babylonians, Charles Dodgson (AKA Lewis Carol), Ramanujan, Martin Gardiner, Thomas Hobbes, Edwin Godwin and goodness knows how many mathematicians and philosophers are waiting for you to join in.
If Zeno's paradox (Does Achilles ever catch the tortoise and can you really clap your hands?) transcendental numbers and algebra are your thing you might do it, but using the Greek rules... it can't be done. You'll end up with a headache and a squircle.
Health managers are faced with the historic equivalent of squaring the circle. Deliver more health services with less money. It can be done; just spend money you haven't got. Yup, but that breaks the 'Greek' rules.
Safe staffing. Yes, can be done but there are not enough staff in the system. Answer, go outside the system. This costs more money and will break some new 'Greek' rules.
Open longer hours. Why not? However, (you know what's coming) this will need more money and more people. There is none of either.
The simple answer to these conundrums is to change the rules.
For example; the rules require Trusts to balance their books year on year. Answer; change the definition of a 'year'. Change the accounting period to three or maybe five years. Give them longer to iron out peaks and troughs and invest in efficiency.
Or, we could change the definition of a 'Trust'. A Trust is entwined with its local health economy. Community care, social and primary care, OOH, emergency care all, in some way, impact on a Trust's ability to balance its books. So, redefine the accounting 'entity' to include all the components seems logical. Balance the books across the whole health economy.
We bust a gut to avoid busting the rules but the rules are arbitrary. Rules that no longer have impact as pretty well everyone is up to their oxters in debt and can't deliver a balance. Are they stupid or is the way the rules are constructed stupid?
Trusts do not 'overspend', they are under resourced for the activity they are required to carry out.
We need 'good rules'. The NHS has bad rules.
Everyone driving on the left is a 'good rule'; we are safer for it, we all do it because it is simple and easy.
Good rules have a name; they are deontological. Obligations, ethics and duties we can accept. As much as we laugh and poke fun at their excesses and the tribe of Little-Hitlers they have spawned, health and safety is deontological. We now it makes sense.  
NHS rules are 'bad rules'. Bad rules are called consequential rules; the end justifies the means. In our case the overwhelming need to balance the books (the end) justifies reducing services, cuts, criticism, special measures, regulation, sackings beatings and bungs. The means...
Am I proposing financial anarchy? No. Should there be a bonfire of SFIs, no.
I am saying we are playing fantasy finance. We have our means and our ends mixed up.
Our common-purpose it to deliver great healthcare. Isn't it? That is our objective, our outcome and our 'end'. Our common 'end' is; safe healthcare, when you need it, in places you can get to, delivered by happy people who know what they are doing.
Two simple changes to the rules; the accounting period and balancing the whole health economy.  Simples.
If the rules governing the 'means' don't deliver the 'ends', obviously, we have the wrong rules. If the 'ends' really are important to us, we need to change the rules.
Violating good rules is a bad idea. Breaking bad rules is inevitable. But, some rules are just old habits.
Maybe it's time to change our habits?

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1st December
King's Fund 5.30pm 
Janet Davies
New boss at the RCN
King's Fund 1st December 5.30 pm.
19th November
King's Fund 5.30pm
Lord Hunt
Labour's Health Leader in the Lords.
A remarkable career; from leader of NAHAT (a forerunner of the Confed) and Trust Chair to the front-line of politics.
This will be an absorbing evening of politics, policy and no few insider secrets (we hope).  In conversation with Roy Lilley; come and hear from the heart of Westminster.
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