8th August 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!
Get on with it
News and Comment from Roy Lilley
I'm not an economist.  Nor am I any kind of an '-ist'.  I rely on common sense and a pile of stuff that I've got wrong and want to avoid doing again.
However, the economy thing worries me.  In the 80's I saw the impact of recession on homes, families and businesses and in more recent times we have all been horrified spectators as the banking crisis gave way to similar misery and austerity-crippling public services.
Now, we're not spectators; we are part of the cast of reality... the economy is a step away from falling off a cliff. 
Most likely...
  • Theresa May's slender majority, economic uncertainty and Brexit confusion will plunge us into a General Election this year
  • Tory back benches will get restless as Brexit turns into Fudgeit
  • The economy will stall.
  • The idea that the Monetary Policy Committee  can make us all rush out and buy stuff by cutting interest rates in half when they are already 1/2% is frankly, potty. 
  • Labour will disintegrate.  
  • May is likely to win an election with a majority of 100+.
Of course, I deliver this killer analysis without the benefit of being an -ist.  It just seems obvious to me.  It's probably obvious to you, too.
You'll be nervous about entering into any major purchases as no job is secure; least of all the NHS. 
Pressures on front-line wage bills, amalgamation of services and back-offices, reduction in the numbers of CCGs, federating practices and Reset will almost certainly hit nursing, lab-staff, administrators, middle managers, Boards, practice managers and head-count.
Mortgage debt, student loans, utility bills, care-home costs, pension returns, rent-rises, lack of investment, next-to-no return on savings, Brexit slashing property values; a toxic combination for uncertainty, ambiguity, unpredictability, mistrust; each one the companion of indecision.
I'm not an -ist, but one way or another, I wouldn't bet against 25k quiet redundancies across the NHS.  The Jim Reaper has to get running costs down.  Ouch!
You'll be thinking what to do about savings.  The obvious; don't bother.  Go and buy stuff.  With a bit of negotiating you'll almost certainly buy whatever it is, at a discount. 
Every 100 has the buying power of 110. Why don't we do it? Coz we are worried about where the next 100 will come from...
Probably the economy has already stalled.  Osborne's austerity policies have wrecked confidence, destroyed optimism and sucked the life out of enthusiasm.
What to do?
Chancellor Hammond, in his October statement will cut VAT and reach for the Keynes playbook.  He'll print money to fund public works; good for the building industry and the economic cascade it produces.
Simon Stevens, in a Telegraph article told us we must refurbish landlocked, clunky, corner-shop primary care.  We can't shift stuff out of hospital unless there is somewhere to shift it to.
Mmmm...  I'm not an -ist... but...
Capital projects need revenue to run them.  Realigning present revenues will only take us so far.  We need more cash to keep the lights on never mind plugging-in new stuff.
There is talk of NHS bonds to fund projects.  It leaves us with the same question; cash to run them.  Prop-Co, or whatever it's called, will flog-off bits of the NHS estate and groom the rest for a flotation.  Potty idea.  We should lease the bits of the estate we don't want for step-down care and dedicated frail elderly services. 
It comes back to cash, not capital.  The NHS needs liquidity. Privatise our way out of trouble?  Forget it.  There is not enough money to make a margin.
Am I a pessimist?  I'd rather be an optimist.  Certainly not defeatist but I am starting to worry how we are going to exist.
There's only one way out.  Become a perfectionist.  Not a pedant nor a nitpicker... but an activist in the pursuit of excellence.
Benchmark, calibrate and compare yourself and what you do, with the best you can find.  You are who you hang out with, be an evangelist for the best and forget the rest.
You can't be a pacifist; you have to go to war on waste, bad practice and indifference.  A strategist for success.    
The future is for the realist and the reality is; the best always was indispensable; now it's obligatory.
  Contact Roy - please use this e-address
Know something I don't - email me in confidence.
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Listen to today's eLetter

26th Sept Kings Fund  5.30pm.
Ed Smith 
Chair of Not-Monitor 
(I must find out what they are called!)
Great evening in prospect.  He has a huge experience and a raconteur 
Plus the usual wine and networking. 
Tickets here
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the wheels are seriously coming off the Capita Primary Care Support contract.  Apparently the Optical Confederation have joined in with their problems.  Clearly there is something wrong; the sensible thing to do is to admit it and fix it... isn't it?  This is no good for Capital and no good the the NHS.
>>  I'm hearing - The Tinkerman will ask the Doc's Pay Review Body to look at modelling salaried GPs in their next round.... Mmmm I wonder why?
>>  I'm hearing - one in 20 GP contracts have been terminated since 2013.
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