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12th September 2016
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Ed Smith
Chair of NHSI in conversation with Roy Lilley.
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News and Comment from Roy Lilley
Mother May changed her plans and left the Tinkerman as Health Secretary.  Now he has to deliver. 
 
I hear May's been laying down the law; there's to be no service cuts, no closures and no embarrassing stories about the NHS.  Ouch!
 
Mother May will never be the Iron Lady but this plastic one is just as scary.
 
On Sunday NHS Professionals' Chris (Beards are so last year dahling) Hopson, wrote in the Observer in terms; 'we are all going to hell in a handcart'.  We know. I've been saying for ages; Five years of flat line funding has hobbled the NHS; five more will cripple it.... look at the big blue bit. 

  
 
Brave of him to speak-out but I expect he'll be out of the tent for a while.  Not-on-message is a crime in Whitehall.
 
May has a problem.  The Brexit-Brigade is the right-rump of the Tory party.  She may only get away with soft Brexit if she looks tuff-enuff about everything else.  That includes the NHS.
 
MPs get a weekly crib sheet of answers to awkward questions, they are called FAQs.  The Tories, when challenged about the NHS are briefed to say; 

'We have funded the NHS' own plan with the £10bn extra they asked for, now they have to get on and deliver the great care patients deserve.'
 
It is at that point Hopkin's gimme-more-narrative comes unstuck... because it is true.
 
The up-front money was cunning.  It sounds like a lot but is tapered and over 5 years amounts to a flat-line.
 
When Tarzan pulled off the deal; a bit more money, a slug up-front, we all cheered.  It turns out the Treasury weren't so stupid after all.  

The upfront money is mortgaged to pay off legacy debt and dousing overheating health economies.  What's left will be paid to the Trusts who have the cojones to tell the best fibs about how they are going to change stuff.
 
Time for some tricky truths...
 
Everyone says the NHS is under pressure... give it more money. 
 
Wrong, if we suddenly had a bung, apart from debts attributable to over-trading, where would we spend it?  We can't buy more nurses; there is a national and EU shortage.  Agency spending is capped.  We have more doctors than we have ever had... but no enough.  We can't order a box from Amazon Prime.  Innovation will take time and no one has time.
 
Everyone says we need a national debate on the future of the NHS. 
 
Wrong; there is no pressure from the public, they love the NHS, neither is there a mechanism for discussion.  If there is a 'debate' it will be led by partisan newspapers or at the next election.  Too late.  Get funding back to the EU average and be done with it.
 
Everyone says the latest big idea, STPs will save the day.
 
Wrong.  Some of the plans are gibberish.  Others are dramatic and unlikely to pass Mother May's Billy Joel Test; 'Don't-go-changin' if you're tryin' to please me...' and even if they did, consultations are likely to drag on for years.
 
Everyone says it is the frail elderly that are the anchor-drag in the NHS.  

Wrong.  The real increase in A&E numbers are the under 40's, fed-up with clunky primary care, appointments, telephone answering and palaver. 
 
Our real problem is Adult Social Care.  The services have been slashed and are running on a whiff of money vapour.  It's broke.
 
Hopkins describes the problem, that's the easy bit.  Can he tell us what to do?

Try these ideas for size....

Don't give any money to the NHS, for health services.  It's too late to spend it to effect.  Give it to the NHS, ring-fenced to spend on adult social care.  TUPE social care staff across, urgent... like next week.
 
Make an immediate change to consultation requirements.  New rules to reflect the urgency of the situation.  Get all change over and done within three weeks.  Appeals to the Reconfiguration Panel turned around in 7 days.  Pull-yer-finger out.
 
Seven-day services; understand this is politics and there can be no climb down.  Define exactly what 7-days means and create The 7-Day-Challenge.  Let them-as-can, do it.  Give them a bung.  Them-as-can't, lay off the beatings until they can.
 
Dump arm's length bodies such as NICE, we don't want anything new for now, thank you.  Subcontract the job to the Scottish equivalent, they are quicker. 
 
The CQC; £250m a year for what?  Telling us the NHS is on its knees.... we know.  Give them £50m and make them use dashboard and data analysis to tell us 'how we did today'.

Re-calibrate targets.  They have lost their currency, impact and are a laughing stock.  NHS joke; 'What do you call a chief executive who says they are hitting their targets?  Answer; A liar'.  No one cares anymore.

Primary care is largely broken.  Integrate it, along with OOHs and community, vertically, though Trusts.
 
Scythe through the undergrowth.  I could do it tomorrow afternoon.  I'd start with the CCGs.
 
Morale and motivation are the biggest challenges.  Only real leaders can sort that; invest in them.  

We should start by stopping. 
 Stop describing the problems...  

Start by coming up with ideas.  

Stop grizzling and if you don't like my ideas, let me see yours.
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HealthChat
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
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
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>>  I'm hearing -the Lister is to be in line from a protest from unions about their cash for pensions deal.
>>  I'm hearing - a new report from the King's Fund will investigate the impact of cuts to social care funding and their impact.
>>  I'm hearing - the NMC is about to launch a back-to-work campaign for nurses.
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Dr Rodney Jones 
Analysis
Where next for overnight stay admissions, length of stay and bed-days?
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The wider use of the Care Record
Dr John Parry says we've got it all wrong.
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Muir Gray's
Guide to Living Well for 
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