23rd May 2016

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Duncan Selbie - boss of Public Health England, in conversation with Roy Lilley
King's Fund - June 21st, 5.30pm
Drinks, conversation and networking 
News and Comment from Roy Lilley
So now we all know.  Really know.  We had an inkling the NHS had run out of cash, we just didn't know by how much.  The official number is 2.7bn.  That's not the full story.
Some say the real figure is much worse... around 3.2bn, 85% of Trusts can't balance.  Half of A&Es risk closure?
All manner of jiggery-pokery has been employed to suppress the real figure; about 670m has been pulled out by accounting legerdemain.  Extra spending amounts to 760m and chunks of capital converted to revenue.
However, there still some savings to be fed back in, to finalise the numbers.
Lets be clear; Trusts have to find 2% of the total the rest will come from savings at a national level and service redesign.   Tarzan spelled it out on the Marr Show on Sunday.
Can we do it?  Maybe but I don't detect a national sense of shared purpose.  I detect people are saying; the politicians have plunged us into this, why should we bust a gut.  And, that is dangerous.
Trusts and others are being forced into action.  Not-Monitor has sent in the heavies. 
The DH is focused on finding the last two farthings.  If the Tinkerman exceeds his departmental expenditure limit, he'll have to grovel to Parliament for more money and that is bone achingly embarrassing.
Who cares?  People say to me; if they'd have given the NHS a decent amount of money in the first place they wouldn't be in this mess.  Let 'em grovel... the service has little sympathy for the Tinkerman's predicament.  
Everyone is busting a gut and no one says thank you.  Let him and the politicians sweat.
The NHS has not had a party, drunk the money or lost it on the second favourite in the 2.30pm at Kempton Park.
Forgive me for covering ground I have covered before:
"As is his perfect, democratic right, the Chancellor has determined that he will balance the books and accumulate a 10bn surplus by 2020.  In consequence he is reducing borrowings, realigning taxes and cutting public expenditure."
He has slashed NHS funding to 2000 levels.  As a percentage of GDP, to below Germany, France, most of Europe... even Greece.  We are on a par with Slovenia and Iceland.  If we had continued to spend at German levels, like we used to, we'd have 20bn more.  Please note; all these comparator countries have been impacted by austerity.
It doesn't have to be like that.  The Chancellor could balance his books by 2025.  He could aim for a 5bn surplus.
Politician's will say; the NHS has a plan and 'we are funding it'.  They are right, the funding equates to about a 1% pa uplift against +4% growth in demand.  The NHS bit of the plan includes squeezing 4% a year efficiency out of the system.  Unprecedented.  

I detect many NHS stalwarts have given up. Everyone will care for patients but are past caring about everything else!
There are  200-odd weeks of the Five Year Plan left.  Time is running out.
Don't think Tarzan and the Jim Reaper are oblivious to any of this.  They've been busy.  Now you see it, now you don't.  It's magic, the NHS is being changed.
The Sustainability and Transformation people are morphing into 40-odd 'footprints' with a 'leader' and are set to become strategic health authorities... a good thing, too.
What works is what counts and what we have now doesn't work.
The deftness and subtlety with which transformation has been accomplished is extraordinary.  STPs will have populations of 1.2m people, integrated services, shared budgets, collaborations and vertical integration... accountable care organisations are on the way.
Spreading the financial risk across the whole healthcare economy, involving new models of care, makes a lot of sense. 
STP strategists will persuade, cajole and bully health economies to amalgamate, merge and federate.  Vertically integrated care, with population based, capitated budgets will emerge.  You'll wake up one morning and there they will be.
No, no consultation.  Don't expect any.  No rules have been broken, no guidance followed.  All this is spontaneous, extemporaneous, improvised.  The boys are jammin'.
Governance, legal frameworks, palaver; don't fuss yourself, it will fall into place.
And then what?  Expect grip.  Painful, eye-watering grip.  Benchmarking, comparisons, data sharing, amalgamations, service realignment, a bonfire of useless boards and an all-out effort to get across the finish line of 2020 with savings in the tin.
When you are bouncing your grand-kids on your knee and they say; 'Where were you in the great health care revolution of 2016?'... you might have to say, you missed it, because you blinked!
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Health Chat
Duncan Selbie
Chief Executive Public Health England
In conversation with Roy Lilley
21st June - King's Fund 5.30pm
New HealthChat
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Sir Andrew Dillon
18th July - King;s Fund - 5.30pm
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