The people have spoken. Unfortunately they seem to have been having a conversation about the wrong things. Most of the agenda has turned out to be lies.
There is a whiff of panic in the air.
Without a well organised opposition the Tories could win an election with any buffoon in charge... and probably will.
Austerity++
On current predictions, Jim says, the NHS will be short �500m this year and it just won't do. He's done the 'coins down the back of the sofa' trick. He is now thinking in terms of selling yer granny. He's looking for �250m.
How?
- He could close down 180 CCGs, leave just enough to have coterminous boundaries with the STPs. That might give him �85m.
- He could reduce the STPs to 20. Savings dunno? �5m.
- He could insist the CQC use digital and virtual inspection and wring �120m out of them.
- He could get all Trusts with retailing on their concourse to aggregate their income, roll it forward for the length of the contracts and sell it at a discount to a merchant bank. That might generate �80m.
- He could do the same with income from elective procedures. Roll it up, discount it and sell it as an NHS bond. �90m?
- He could close the Leadership Academy, privatise HEE. �5m?
- He could dump the Carter report and all the palaver that goes with it. Just cap non-pay expenditure. Find out what the average is, reduce it by12% and Bob's yer Uncle, there's the base line and maybe �8bn in his back pocket.
Expect none of that. Expect, instead and unbelievably dreary, risky assault on back-office (dreary) and staffing (risky).
He's giving everyone 30 days to plan a consolidation of back offices. That means HR, finance and maybe estates.
That means putting people on notice of being at risk, get IT systems matched up and inter-operable, agree systems and reporting structures and be generally distracted and palavered.
Probably, a layer of middle management and a sprinkling of senior staff is all you'd save in the short term and the numbers would creep back.
Or, they could go out to tender; ship the whole lot out to India, Ireland or someplace robust enough to take it on. I imagine that would take two years, and cost a fortune to write tenders documents.
You'll remember Lord Carter had a go at consolidating pathology services. It didn't work. Jim's having another go. First he should ask why it didn't work last time; why would it this time.
Technology has moved on. For most routine work near-patient-testing is suitable for use by GPs and probably Trusts, too. Complex testing should be consolidated. Jim's right.
The next big idea; staffing. As far as I can see, cutting pay cost growth. Yup, I know what you are thinking... safe staffing?
Forget it. Robert Francis has, the CQC has, the DH has, NICE has. Nurse patient ratios will be set like they always have; by the finance department.
Jim says he's consulting with the CQC about patient safety. What do they know? They are experts in un-safe.
Don't bother, I'll tell you; unless you protect the front-line, fund it properly and make it fun to work there... you'll go to hell in a hand cart.
Examine the distribution of Trusts with staffing problems. They are always a prisoner of geography and the local health economy.
Options?
Cap pay-spend, let Trusts sort it out. To keep safe they still have to hire people in line with demand. If they don't expect waiting lists to grow, complaints to rise, staff to leave.
Recruit over a wider area, share staff and risk.
Live rostering, abandon shift working get staff to come in when they are needed on zero hours contracts.
Subcontract the whole nursing staff to the private sector and let them have the headache.
Tricky old job Jim's got, ain't it?
Some Trusts have lost the plot on their finances. They are operating in panic mode. Throwing money at problems. Jim will help them back on track.
But, he can't deal with root cause...
The Chancellor decided to balance the books by 2020 and accumulate a �10bn reserve. He can't raise taxes or borrow more, hence expenditure takes a hit... that means schools, prisons, health and social care.
Right now we have no idea what government plans are. One thing is for sure...
Expect more letters from Jim.
