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16th December 2015
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Health Chat

14th January King's Fund 5.30pm

Professor Sir Cyril Chantler

This will be a great evening!  Must come! 

The inside story of the history of the NHS and what next!

Tickets here.

Bedlam
News and Comment from Roy Lilley
I've always wanted to be an astronaut. These days I'm closer to being a gastronaut. I sat on the sofa watching Major Tim blast off from Kazakhstan. Have we forgotten it was Helen Sharman, who did it for us first?
 
Did you notice, unlike NASA, there was no 5-4-3-2-1. Just a 'lift-off'. The Russians don't use a countdown. They say the enthusiasm and the ramped-up heat-of-the-moment might result in someone overlooking a warning sign. They use check-lists. Management lesson for the day!
 
The technology to do all this, a wag on the telly said, it wasn't rocket science!
 
It was the Pennsylvania newspaper The Daily Intelligencer, December 1985 that wrote:
 
"Coaching football is not rocket science and it's not brain surgery. It's a game, nothing more."
 
... as Chelsea's Mr Mouriniho is finding out! It was George Bush who later gave us; 'it's not rocket surgery....'
 
So, if building a rocket, sitting a man on top and firing him into the heavens isn't rocket science, what is?
 
I'll tell you what is....
 
There's a very important report out this morning from the Audit Commission. It's about the extremely dodgy NHS finances. How we fix it; that will need rocket science.
 
The deterioration in NHS Trusts and FTs has been worse than expected; an £843 million deficit in 2014-15 representing a sharp decline from the £91 million deficit reported in 13-14.
 
The bigger picture is worse; commissioners, Trusts and FTs, together, moved from a surplus of £722 million in 2013-14, to a deficit of £471 million.
 
Monitor et-al saw it coming and made Trusts rework their biz-plans. Jim Mackey, the new King Herod of the NHS, is threatening sale of the new born if Trusts don't get back into balance. Overshooting the DH departmental expenditure limit will bring a plague of locusts.
 
Enter Amyas Morse, head of the National Audit Office;
 
"We said in November 2014 that the trend of Trusts' and FTs' declining financial performance was not sustainable. We repeat this view today."
 
There was more;
 
"The government's commitment to give the NHS more funding, with almost half of this coming upfront, could be a significant step towards financial sustainability, if this funding can be devoted to improving the financial position of trusts rather than dealing with new costs."
 
So forget seven day working and the rest of the latest wheezes.
 
There was bit more that if it is not a nod and a nudge to a blind donkey, I don't know what is:
 
"The NAO warns that effective oversight by the Department and its arm's-length bodies will become harder if the number of trusts in financial distress rises further. While the Department and its arm's-length bodies have taken steps to learn how trusts could reduce costs, the wider use of this learning and how it will improve trusts' finances overall is not clear."
 
"... making savings through the redesigned models of healthcare will be challenging. The NHS' new models of care aim to integrate services around the needs of the patient, but are relatively new and untested."
 
Message there for Lord Carter of Bog Roll and his tickbox plans for the perfect hospital. However, I think the Vanguardistas are misunderstood. They have never promised to save money; they are all about using what we have more efficiently.
 
Rocket science won't help. Too late for a miracle? A common-sense revolution might work.
 
View health economies as a whole (Tarzan has hinted he might do this) and abandon the pressure on Trusts to balance. Give up the failed idea to get GPs commissioning. With a handful of exceptions, they are just buying what they bought last year and having a row about the money. Change to population based, capitated budgets, just do it.
 
The competing priorities and punch up, created by the Tinkerman's arm's length bodies: King Herod threatening castration if we don't save money; dithering NICE issuing and withdrawing guidance and the numpties at the CQC telling us hospitals aren't safe, need more nurses and another ChEx; HEE running up the down escalator of cuts in training posts; a national shortage of staff; the DH stirring up a strike; locum agencies buying new Bentleys on the strength of it all... leave Trusts with nowhere to go.
 
This is not management and it's not rocket science. It's bedlam.
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Sir Cyril Chantler
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