22nd July 2016

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Ed Smith
Chair of Not-Monitor, or whatever it's called.  In conversation with Roy L
Good conversation, networking and a glass of wine.  What's not to like!
Don't get trapped in the past
News and Comment from Roy Lilley
History has some famous and interesting letters.
Benjamin Franklin; 'Advice to a young man on the choice of a mistress'.  Kafka's rather strange love letters.  The Dreyfus affair.  The Zinoviev letter and the Letter on Corpulence, from William Banting... that started the diet-thing.
For weeks the NHS has been in the shadow of an impending letter.  Strong men and women sitting, wringing their hankies in expectation.
Fear no more; the Reset Letter was published yesterday.
First, the good news; 1.8bn for Trusts to help land on a 2016/17 provider deficit of 250m; fines replace incentives and targets relaxed.  Tailored targets and bespoke performance measures.  Recognition; not all Trusts are the same.
After that it gets tricky.  If you work in a CCG, buy a tin hat.
CCGs, of which, in my view, there are too many, performing too poorly, with too many people not knowing which way is up... are in for a wake-up-or-be-beaten-up, call.
Performance measures, cost caps, intervention regimes and ouch... lots of ouch.  Procurement savings, pathology, temporary staffing caps... ouch, ouch, ouch!  Some disbanded... double ouch, ouch!
Think about it.  Great names in the high street get the stuff we want, at the price we want, in the places we want, because they are good at buying.  Quality, quantity, price, delivery and service, the outputs from great purchasing, procurement and commissioning.
CCGs have had an easy run.  Buying what they had last year, screwing Trusts down to do it... less 10%, doesn't hack it anymore.  Some CCGs are innovation free zones.  Hiding in the long-grass of contracting... those days are over.
There is a lot of code in Reset.  I'll spell it out; expect A&E closures, elective surgery centres, CCG's dissolved, merged and management ousted, new targets and special measures. Vertical integration, payroll caps, spending limits, performance trajectories, key waiting standards. 
The CQC; running along behind, like a Chihuahau in a wolf pack.
Individual finance and HR departments will close as will communications teams, estates and everything else that is not patient facing and can be run centrally, aggregated up and merged.
Get in first, ask yourself; 
  • Why are you doing... 
  • What you are doing...  
  • Where you are doing it?  
If you are sensible start planning for back-office departments to work from home.  Offices cost money.  Ask and fix it... before somebody fixes it for you.
A one-way-street?  No, whatever cash is left in the sustainability fund will put some grease on the wheels.
By the time you read this you will know; Barts, Croydon, Maidstone, Norfolk and Norwich and North Bristol, are in special measures.  They are good people struggling with legacy, geography and melting health economies.  My guess; they will welcome the support... their finances shot to pieces.
There will be reams of paper, guidance, explanations and billet-doux delving into the minutia of what is really dumping the Lansley Reforms and an NHSE/I coup, taking over running the NHS.

The Big-Beast, David Nicholson, grip-meister, must be having a quiet chuckle.

Get ready to explain some brutal bed-closures, service 'reshaping', shifting and moving and not much in the way of consultation. 
The prospects for success?  Good; provided the Tinkerman and the DH keep out of it.  Tarzan and the Jim Reaper can probably fend of the real enemy, the Treasury.  They can deliver this.  The Tinkerman who is toxic, cannot.  His job is to visit the front line and smile and be very nice to Chancellor Hammond.
Reset needs time and space for these two trusted leaders to get the NHS back on its feet.  It does not need political harassment, meddling, pulling up the roots to see how it's doing, bullying, badgering or a heap of new daft ideas to cope with on the way.
I've seen this coming.  I've tried to point it up in our daily conversations.
Here's what will happen next.  The commentariat, the nay-sayers, the know-betters, the politicians, the point scorers and the 'I told you so's' will all have reasons to resist some, all or part of Reset.  As will the safe-staffers who will be watching like hawks at the pay-bill cuts. More here.
The special-case-makers, the we-are-different-people, the purveyors of snake oil, the what if-ers and the know-betterers will all have reasons to find a bandwagon to jump on.
Let me spell something out:

We face these difficulties not because we have been doing something wrong.  They are because we have been doing something right; trying to run a ten guinea health service on ten shillings. Be proud of what you have achieved.
We only have room for one bandwagon; crammed with positive thinkers, innovators and sharers who are hard headed, tough minded and realistic.  Our difficulties are not finding new and better ways.  Our biggest problem will be escaping from the old ones.
Don't get trapped in the past.  

Have a good weekend.
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This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - Hinchingbrooke are having another go at survival with a 'merger' plan, that is not a merger plan with Peterboro.
>>  I'm hearing - the BMA say that becasue of Brexit, it will take 20 years to do 7-day services.  WTD and staff shortages.
>>  I'm hearing - a ticket for the upcoming NHSProviders conference is going to cost you 445.  Do they understand about austerity and budgets and money and stuff like that?  Unless you are prepared to pay for your own ticket, don't even think of putting it on your department budget!
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Winter is coming and the NHS is like Game of Thrones!