Why public service leaders are so supine in their dealings with politicians baffles me. Politicians; they work for us. Remember that. They are more vulnerable and insecure than you might think. Their preoccupation is to get re-elected. They need to be nice to us.
Right now the Tinkerman is preoccupied with balancing NHS books. The DH is given our money from the Treasury, via votes in Parliament. That becomes the Tinkerman's Departmental Expenditure Limit (DEL). Spend more than that and he has to go back to Parliament for more money. Very not good!
He has the additional pressure of being one of the few ministers sitting at the Tuesday Cabinet Meetings who has had additional funding. We know it is miniscule-additional but that is enough to make him unpopular with other ministers of state, juggling cuts.
He dare not bust the DEL. It is out of the question. Hence the pressures on the service are worse than at any time I have experienced.
Services accused of overspending are simply underfunded for the activity they are required to carry out. And... the NHS outstrips the UK economy in productivity gains by a country mile. (More here, must read)
Pressures to balance the books invariably translate into harebrained ideas; no Lord Carter will not find �5bn of efficiency savings in the next 222 weeks. It will be fun to speculate how much money he can get rattling in the tin. We might make a few quid with Bet365.
The short term measures to preserve the DEL are oblivious to what could be achieved with open minded thinking and realigning investment.
For instance, we throw away �222m on inspection and the ineffective CQC when we could be investing in the dashboard systems they have in Clydebank.
Why don't we?
First, it is in Scotland, run by the Tinkerman's political enemies and second the NHS is in the grip of austerity-itis; a disease that turns good people, bad.
Some of the hospital trusts that are most in the red have been told to use "headcount reduction" to reduce their deficit for 2015-16.
The order.... in a letter Monitor and the TDA sent on 15 January to every one of the 241 NHS trusts they supervise.... outlined the measures they needed to be take.... to make their books balance. The letter, signed by the TDA deputy chief executive, Bob Alexander and Monitor's Stephen Hay, says:
"We will be meeting a number of challenged providers this month to agree a set of actions, including headcount reduction, additional to the current plan, with the clear intention of improving the financial position of those individual providers."
I have met and admire Bob Alexander. He is a good man, an experienced man, highly regarded as an expert on NHS finance. He is NHS through and through. What in the name of your god and mine has prompted him to put his name to such ludicrous, absurd, dangerous, inflammatory rubbish, I cannot fathom.
Why has this man, who well-knows the pathway to Mid-Staffs was a map defined by cutting staff to balance the books, destroying his reputation by doing this?
Stephen Hay? Never heard of him. My advice; you might be better off in the ranks of B&Q where you can make a living selling equipment that would help us trim the things we want to cut. There is no room for this in the NHS.
Two (probably) good men reduced to doing the Tinkerman's dirty work to keep his place around the Cabinet Table and avoid embarrassment in Parliament.
Why don't they say; 'we ain't gonna do this'. Boards should have nothing to do with either of them and their dangerous cockamamie plans. Long after Hay and Alexander have gone it is Boards who will carry the can for what we know to be inevitable.
Monitor must withdraw the letter and start again. Give the problem back to the Tinkerman. Austerity is his creation.
Yes, the NHS should crank-up a gear on innovation, efficiency, thrift, savings, invention and prudence. But, let's remember Robert Francis... before he becomes a footnote in history.
Sec 1.14
As a result of.... staffing policies, a completely inadequate standard of nursing was offered on some wards.... inadequate staffing levels.... poor leadership, recruitment and training.
.... staff did report many incidents which occurred because of short staffing,
.... in relation to staffing... a dangerous situation had been allowed.... to develop
The State and politicians, may respectfully ask for our agreement on many matters but cannot ask us to turn good men bad and repeat, blindly, the follies of the past.