18th March 2016

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Jim Mackey boss of NHS Improvement Tickets here 
Last few tickets.....

Didn't budget for that
News and Comment from Roy Lilley
The Sugar Tax.  Good idea, bad idea? Will work, won't work?  I dunno.  All I know is it probably points up a change in direction, sets the tone.  There is no silver bullet but there is silver buckshot; the Sugar Tax could become one of a raft of measures that will contribute to tackling obesity and diabetes.
England; just under a quarter obeseWe are fatter than the Germans, or our neighbours from Sweden, Italy and France.  Diabetes; 3.2m of us. We come number 4 after Sweden, Netherlands and Denmark.
I have no idea how making a bottle of drink more expensive will help, nor if the manufactures will reformulate, but it is a start.
The sugar thing is the last thing we have to worry about in this budget (key points).  There is a hidden tax that no one talks about.
The Chancellor wants to balance the budget (full technical details here) and have a 10bn surplus by 2020.  Fair enough.  Unhelpfully, the global economy is slowing down, the UK is not getting efficient enough, fast enough and public services eat money:
  • 2019/20 will be toughest; enormous pressure on departmental budgets as the Chancellor runs out of time to fulfil his promise.
  • 3.5bn additional cuts to (unprotected) departmental budgets will be needed and remember they will have already fallen, in real terms, by over a third since 2010.
  • 2019/20 requires the NHS to stump up a 650m increase in contributions to unfunded public sector pension schemes, wiping out any increases in real-terms funding.
  • Increases in the national minimum wage will slice into budgets.

It seems my 'big-blue-bit-of-death' PowerPoint slide has gained a new currency!

It would be easy for us to look across the road at our distant cousins in other, unprotected, public services, thank our lucky stars and walk on by.
We can't.  Our fortunes are entwined.
We struggle with delayed transfers of care because the pivotal people needed to organise it don't have the resource to do it.  Their budgets will have suffered a 30% cut and that hurts us.
The number of people +85 has increased by 30% and public funding for older people's social care has stagnated.  Indeed, Councils have cut back:
  • From 2010/11-14 funding to councils reduced by 19.6%.
  • Despite increasing the proportion of budget spent, on average, by councils on adult social care, to +40% in 2013/14, the actual cash amount spent decreased on average by 20%, 2011/14.
  • Only 13% of councils considered people with 'moderate' needs eligible for funding in 2013/14, compared with nearly half in 2005/6.
You don't have to be an economist and you don't have to be interested in numbers... anyone can see; there are going to be hundreds of frail old people marooned in the NHS because Social Services are skint.
However, here are the numbers that no one wants to talk about.  

Local authorities pay between 385 and 700 a week for an average care home placement.  In the self-same care-home, in the same building, with the same care, meals and all the rest, self-funding families pay anything from 1,200 to 2,500 a week.
How is this justifiable?  Discriminatory pricing may well be unfair trading and unlawful.  It seems to me the consumer may require some protection from blatant underhand pricing.

I have never heard the Patients Association (them again) or care home campaigners even whisper about this injustice.  The care home operators certainly wouldn't want to talk about it!

By 2019 as social care faces swingeing cuts there will be a downward pressure on local authority care home fees and an upward pressure on self-funder fees to compensate.  Funding families could end up with a bill of 3k a week.

It looks to me; families are subsidising the care home system?  It is a hidden tax on relatives who end up selling family homes and memories to pay for their loved one to be looked after... plus a complete stranger. 
They didn't budget for that.

Have a good weekend.
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Jim Mackey
Chief Executive
NHS Improvement
In conversation with Roy Lilley
King's Fund 
14th April
Buy your tickets this week.  It is close to a sell out..
Chief Executive and Registrar of the GMC
Niall Dickson
Hugely interesting career as a regulator, the King's Fund and the BBC.
A great night in prospect.
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Lord Carter of Coles
In discussion with Roy Lilley all about his report and the price of bog rolls!
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More fabulous analysis
The NHS is getting closer and closer to the car in front...
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the BMA are complaining the budget didn't boost NHS spending; that is because it is the budget and not the spending review.  You'd think they would know that?
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