Last Sunday afternoon I had occasion to walk thorough Fabulous Frimley Park's glamorous, new A&E waiting area.
It was standing room only. Their tastefully designed, airport style, modern waiting suite, furnished with sweeping sofas, had more bums than it had seats.
It struck me; it could have been EasyJet. I'm guessing, the age range was late teen to 55yrs. Casualties from Sunday football and victims of gardening? Not a frail elderly person in sight.
Why were they all there? I dunno, I guess someone does? One thing I do know; when Fabulous Frimley overflows; "Whitehall, we have a problem".
The long awaited 'reset' letter, from Tarzan and the Reaper, is casting a long shadow. 'Reset' is code for 'get your act together'. Through sleight of hand, imaginative accounting and financial water boarding the year-end figures will be near enough.
... mainly because of the in-year bungs to help Trusts sort their finances. Bungs that, sometime-somehow, will have to be repaid. Expect fiddling with capital structures.
We have scraped through. Just got over the line. Whats next? What is next is to make sure the wheels don't come off again.
I doubt we can't give that assurance.
We cannot say 'never again' because we all know, when the A&E waiting area of one of the best hospitals in England, is standing room only at 3 o'clock on a Sunday afternoon, something is very, very wrong with the system.
Young to young-ish, walking wounded filling up A&E tells me something. I'm not sure what it is but it tells me something.
The NHS is obliged to provide more care than it is funded for and no amount of Jim-Reapering will fix it. It might fix-it-up in the short-term but will it fix it, fix-it.
Yes, we can benchmark, compare, contrast and audit. That gets us to a new average. We can pull the plug on the CQC's unrealistic insistence on a gold-plated services... what we've got is good enough. That'll keep us ticking over.
Yes, we can grip staffing costs draw a line, get better at rosters, scheduling and changing work patterns. That leaves us treading water. Dangerous water, with treacherous undercurrents.
Yes, we can buy cheaper bog-rolls, turn out the lights, sack people, merge CCGs and all the rest. It will keep us afloat.
Historically, the NHS managed something like less-than 2% efficiency gains, year on year, if we are lucky. We need more than 4%. We are running up the down escalator.
Demand is outstripping our ability to cope and pay for what is required. From that flow two choices. Find other ways of paying more for our NHS or do something about demand.
Something about demand? What 'something?
Diverting the flow of patients to GPs, out of hours and all the rest is confusing and anyway the public don't want it.
Tarzan is talking about beefing up primary care. Do we have time? Perhaps he knows something we don't?
The public know where hospitals are and that they are open 24/7. They can park. There might be some hanging about but they can get in, get diagnosed, get fixed-up, get out and get on with their lives.
The five 'gets', the Holy Grail of healthcare.
In retailing they say; follow-the customer, find the money. In health we might say; follow the patient, save the money. Put the resource where the patients want to use it. That might mean disinvesting in primary care...
The supermarkets killed the high street, didn't they?
And the money? There isn't any... until the politicians want there to be some. My guess is Chancellor Hammond will find some for us.
So, don't worry about 'reset'. You can only do your best and soldier on. It's bump-start, reboot and the jump leads you should be worrying about.
There is much worse to come. And that's the point...
There is only us. No one is going to rescue the NHS other than the people working in it. There are 1.3million of us who know something, somewhere could be done better, quicker, slicker, faster, cheaper, smarter, bigger, smaller, beutifuler, craftier, defter, louder, softer, flexier, brighter and shinier.
Don't wait for permission - I give it to you now. JGDI.
And don't forget; 'got there' is an anagram of Together...
