15th November 2016

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HealthChat - Xmas Special
Simon Stevens
In conversation with Roy Lilley 
If you plan on joining us, do it now, tickets will be sold out by the end of the week
6th December - King's Fund - Details here.
Dig them out
News and Comment from Roy Lilley
It looks like more money for social care is a done deal.  The weekend papers seemed to agree; a combined lobby from health and social care bosses and the Tinkerman has talked some sense into the big brains at the Treasury.

It's likely that the social care precept-cap, allowing local authorities to raise 2% for social care will be upped.  

All well and good.  However, the problem is; precept hypothecation works best in wealthy areas where income is at its highest and care is at its best.  It doesn't work in poorer areas.  

It's called the inverse square law.  The poorer the area, the greater the demand for services.  The richer the area, the better the services it is likely have.

The Chancellor's other options are more borrowing or cuts to other budgets to fund a bung.  I can't see a tax-hike is in the offing.

So what happens next?

It depends on how soon the money becomes available.  A bung would work best.  An immediate injection into local authority services to try and keep vulnerable people out of hospital and smooth their exit when they are in.

The precept-thing has to wend its way through Council bureaucracy. 

How will they spend it?  Are they able to beef-up services in time?  Throwing money at a problem generally hikes up inflation and resets baseline costs.  

A sustained period of sensible investment, keeping pace with demand is a cherished management memory.  This is panic planning; akin to petrol on the fire.

Any new money will have to include an element to be spent by the NHS.  This is especially true of re-enablement.  The current models that turf people out just as soon as possible doesn't work.  Step-down care is not a luxury, it is sensible; getting people match-fit and ready for life at home.

There's a lot more that could be done.  Compile a list of vulnerable people and visit them everyday; spot a decline or a risk and fix it before it becomes and admission.  Calculating the ROI on that is tough.  Can you put a price on what didn't happen?  If it saves money, who gets the savings?

Discharge to assess is becoming the gold standard.  It is clear people have a lot more acuity in their own surroundings and with a few simple aids and adaptations, often need less help than we might think.  

The fly in the ointment is getting all the services whistling the same tune and being available to march to the point of discharge, at the same time.  An alternative is to give the local authority element of the care-cash to Trust OT departments and let them make it all happen.  The Better Care Fund can do that.

This is the crux issue.  If we are to get patients out of the NHS's back-door we have to get better at opening their front door.

And... don't ask about the complexity of VAT.  Social care stuff, a handrail, is means-tested and VAT-able.  NHS isn't but the delivery of the hand rail, if separated out, might be reclaimable.

If the NHS really got to grips with VAT the Jim Reaper might find all the money he wants in one year.  However, that is a story for another day.

Today what concerns me is... well, how shall  I put it?  If the NHS were a patient it would be very sickly.  Social services would be in ITU.  Move either of them onto a rich diet and you'll probably make them sicker.

Last minute bungs, famine and feast funding, emergency cash is all very well and always welcomed but it invites knee-jerk solutions, inflation,  rip-off suppliers and panic buying.

We will have to dig ourselves out of this mess but the message is obvious; a clear, long-term funding commitment for health and care services creates a healthy health-economy and creates the time and space for careful care planning.

It is politicians who voted for this mess.  Make no mistake, the problem starts in Westminister.  Any politician who voted for austerity economics, hobbling social care and crippling the NHS dare not carp about the predicament they dumped us with.

Politicians can expect closures, cuts, curtailment and a crushing avalanche of complaints from their furious electors.  Good.

I am totally disinclined to dig them out.
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Simon Stevens
6th December
Selling out fast.  Be quick!
King's Fund
Guest editorial
Dr Malcolm Oswald
Writes exclusively for us about
Citizens' Juries.
Are they the answer to the 'consultation problem'?
This is what I'm hearing;
if you know different,
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>>  I'm hearing - absolute panic at NHS Digital when they realised the extent of the broadcast email error!  Ouch!
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