8th April 2016

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Do their best
News and Comment from Roy Lilley
One way and another it's been a grim week.  The NHS seems grey and stuck.  Apart from the strike... 
... no matter how much huffing, puffing and Tippex is used; you can only spend a pound once.  I get the impression people have given up.  Past caring.

Balancing the books is something the NHS used to do. There's not enough money in the system to cover the activity the NHS is obliged to undertake.  So; Not-Monitor... do your worst.
The finance wizards will produce a fudge to rescue the Tinkerman and his DEL.  Past caring.  Do your worst...
Quality?  There was a time when the CQC used to get people scurrying around.  Not now.  The CQC is a laughing stock... everyone is in the same boat, past caring... do your worst.
There are only 3 things I can see the NHS really has to deliver.  Not to do so makes political masters look very bad:
  • hitting targets and it isn't;
  • balancing the books, it can't;
  • sorting out the wreckage of the 7-day-madness 
No one is that enamoured of politicians they want to put themselves out.  The Tinkerman has 'lost the dressing-room', so to speak.  So, 'they' can do their worst.
Targets?   They'll have to be recalibrated.  End of.
Balancing the books?  The big problem is staffing.
Squeezing Trusts gave us Mid-Staffs.  Mid-Staffs gave us the Francis Report.  Francis gave us 'safe staffing'.  Safe staffing gave us barmy CQC reports and a rush to hire non-existent staff.  Staff shortages gave us a scramble for agency staff which gave us a hike in fees. 
A cap on agency fees hasn't worked.  Safe staffing is now a fad from a distant past.  Francis joined the CQC, the Patients Association and threw in the towel.
The next fad will be Carter's 'care-hours-per-patient-day'.  Safe staffing in drag.  So what?  More numbers to fiddle.  Head count will be cut... do your worst.

Mid-Staffs is set to repeat itself.
So, what will the big brains in Whitehall (forget the DH, Number 10 is running the NHS these days) decide are the answers to spare their blushes?
Still to come in the repertoire of madness is the CQC's new responsibility for Trusts' financial performance.  Where's the evidence the CQC can balance their own books!  You can only spend a pound once... so, do your worst.
Regulators will squeeze Trusts and reach for special measures.  That's all they ever do... so, do your worst.  

Bungs or beatings?  Beatings, they are cheaper... do your worst.  Nothing holds any fear any more... everyone is in the same boat.  Past caring.  Do your worst. 
Sack a board or two, so what.  The cost of interims will sky-rocket... past caring, do your worst.
Over fifteen years total NHS productivity growth was 4.1%.  Under the coalition government productivity averaged 1.6% per annum.  Past caring.  Do your worst.
The 7-day thing.  Number 10's problem, not the NHS.  Everyone knows the NHS is open 7-days and the juniors are there.  It's the rest they need to get to come in on Sundays. 
Go back to the original 10 domains approach and ask Uncle Bruce, very nicely, to lead a sensible work stream.
Meanwhile GP land is drowning.  Cheapest solution?  The usual; some sort of a plan and a promise to reduce bureaucracy.  It's cheap.
What else?  'New Models of Care?  Very sexy at the moment but they take ages to organise and what models? 
Accountable care organisations, vertical integration and population based, capitated budgets look good.  Reduce the +200 CCGs to 10.  Swap commissioning for outcome-based, care-pathways.  Who has the cajones?  Who cares.  More change... do your worst.
Social services?  Give them more NHS money?  But, you can only spend a pound once, so do your worst.
The NHS is suffering from collective Urbach-Weith disease.  It no longer fears fear.
Politicians on the other hand, suffer from:

"... a belief they are immune from the immutable laws of management, a phobia about learning from the past, indifference and a lack of coordination.  

There is also a disorder aligned with wife beating; 'lovely on the outside but beat the staff up when they get home'.  

Add to that management by fad, idolising upwards and disdaining downwards, greasy-pole syndrome, band-wagon jumping, means-justifying-the-ends-itis and the belief you can spend a pound twice."
Alternatively you could pause all new stuff, suspend regulation and targets, give the time and space the NHS needs to catch its breath, re-establish a respectful relationship with Whitehall, find out what good looks like, copy it and...  do their best.  
Have a good weekend.
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