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1st April 2016
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April fools
News and Comment from Roy Lilley
The trajectory and time frame for austerity are political decisions.  The Chancellor wishes to balance the books and have a surplus by 2020.  No nation wants to live with a trail of debt or to spend more than it can generate.  But, how soon we live without debt comes with a cost.
 
The cost is 'consequences' and nowhere are they more obvious than in the NHS.  For instance:
 
Changes to pension funding will mean pretty well any additional/new/recycled NHS money will be wiped out by employers' contributions. A huge hit on the balance sheets for an organisation employing 1.3m people.
 
Changes to the minimum wage, as welcome as they are, will have a huge impact on Trusts, employing thousands of the likely beneficiaries.
 
Changes and 25% cuts to the 'Whitehall Budget' resulting in arm's length bodies moving to full-cost recovery.  In the case of the NHS, that means the CQC (them again).
 
The CQC consumes about 250m.  We get little identifiable ROI.  After 16 years of this-and-that approach to inspection, hospitals are no safer, no better run.  

All the pressures that distract Trusts from focussing on front-line performance (where real quality comes from) are out-with the control of the Trusts and the influence of the CQC.
 
As the Tinkerman comes to the end of his time as our boss his legacy was to have been quality, improved by inspection and regulation.  He has failed.  Failed because inspection never improves quality.  He wouldn't listen.
 
Presently the CQC get about half their income in fees from the organisations they inspect and the rest from government.  The government grant is to be cut by 25% over the next 4 years.
 
That means the CQC have four years to find a way of trimming their approach and efficiency by about 35m.  I make that about 700k a month.  Tough call?  No, not really.  But too tough for the ideas-desert that is the CQC Board.
 
With an eye to their commodious lifestyle their best idea was to consult on how fast they could put up their fees; over two or four years.  

Note: they embarked on getting the money in before their consultation on structures and functions is due to be published in May!
 
The service, understandably, unanimously chose the four years.
 
The CQC ignored the outcome and opted for two years... hard landing.  The 4 year option was never on.  This was a faux consultation.  The CQC have no idea how to shift costs from their 1960's model of clip boards, hotel bills and charabancs.
 
For a small Trust the cost of regulation goes up by 75%.  From just under 80k, to 137k and in 2017/18, up to 216k.  Yup, on the way to a quarter of a million quid.
 
Or, put another way, the Trust might have to sack half-a-dozen nurses to pay for the CQC to turn up and tell them they don't have enough nurses.
 
GP surgeries are looking at a triple rise.  However, as the Tinkerman needs to avoid opening another front in his battle with the Doctors, the DH will bung practices enough to cover the initial uplift.  There after the Docs face a near sevenfold whacker by 2017/18. 
 
There are about 8,000 practices, so that bung will be a fair few million we might have spent on the luxury of a few more AHPs, DNs and front line professionals... to help improve the quality of care.
 
The acquiescent Confed, Employers, Professionals, NAPC, Alliance, BMA and the rest have just sucked it up.  Time to spotlight their commodious membership fees, methinks.  VFM... I don't think so!  They should advise members not to pay.

If no one paid what could the CQC do?  Close the NHS?  The DH would be obliged to do some top-slicing jiggery-pokery; let them do it.

The CQC is not effective; woefully behind on inspection deadlines, overshot their budget, can't recruit, made a mess of the new Guardian role, slow to react and produce reports that are out of date by the time they are published and in many cases hotly contested.
 
This organisation is moribund, stagnant and adynamic.  It has a new chairman.  Now it needs a new chief executive, a new bunch of NEDs and a new narrative.  

The chairman must say to Ministers;
 
"Sixteen years ago, when Wembley Football Stadium was demolished and Reggie Kray died, the CQC started inspection with the only tools they had.  Visits and a clip-boards.
 
Since then things have moved on.  We have access to data, ways of interrogating and interpreting it and new technologies to present it.  The future is in dash-boards, polling, social media, benchmarking, outcome comparisons, monitoring and capturing opinion, complaints and compliments.
 
We will invest in new technologies so that we can all know, in real-time, what is happening in our NHS.  Good and bad.  The Secretary of State, Chief Executives, all staff, (on an App), the public and the press... we will know at the same time."     
 
If the CQC can't save a few quid, up its game, change the players and answer the question, 

'How did we do today?' 

...for less than 200m... we don't need them.  We are not April fools.

Have a good weekend.   
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Autism
New BBC Drama puts Autism in the spotlight and Saturday is World Autism Awareness Week.
A Dad Writes for us; a plea for more training for staff and better adult services.
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Guest Editorial
Physician Associates
Carol Munt
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Chief Executive and Registrar of the GMC
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Hugely interesting career as a regulator, the King's Fund and the BBC.
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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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'A fatal Flaw on national mortality-based disease surveillance'.
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>>  I'm hearing - Junior Doc numbers are down; 0.5% on the year.  Not sure if it is a significant move?
>>  I'm hearing - Virgin's Staffordshire deal has been delayed by a month?
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