I wonder what the Captain Mainwarings at NHS Providers and the Confed will do now?
For months they've been predicting the end of life as we know it; if the Treasury remained deaf to their demand for more money for the health and care system.
As lobbyists, they're not much cop. No one listened... no one got any money.
Stephen Dorrell, former Tory Health Secretary, now chair of the ConservativeFed, cut a
Steven; Chancellor Hammond will not come back to the House with more money, a coalition with Alan Milburn and the LibDem bloke will cut no ice.
Writing to the papers about The Tories and the care system is as influential as an entry in Bridget Jones diary.
Yesterday belongs to no one; today belongs to the people with new ideas and tomorrow will be owned by the people who put the best ideas into action.
If memberships are as comprehensive as they claim, it must mean all Trusts join both Providers and the Confed, for fees of around �3k a pop. Collectively the two organisations might be sucking �900,000 out of the system on membership fees, alone.
If I ran a Trusts I'd want my money back!
The King's Fund, the Nuffield Trust and the Health Foundation are in a similar predicament. How ever elegant their arguments, clever their analysis... no one's listening.
Being sniffy about STPs is their latest fancy. Their combined brain boxes have been unable to come up with any helpful suggestion over and above 'we need more money'.
Now, we are all facing a bigger problem...
We are dangling on the petard of the 5 Year Forward View.
It is too easy for Ministers to say; '...the NHS has a recovery plan and we are funding it'. accompanied by some sinister threats.
Published in October 2014 The NHS Five Year Forward View set out a shared vision for the future based around new models of care. All the big players had a hand in its compilation.
The technical documents prepared for the Health Select Committee, show the demographic pressure base case (as of 2014), partly based on calculations from the Nuffs; a manageable growth in demand. Similarly, the unmitigated non-demographic pressure base case (as of 2014) is thoroughly thought though.
What's gone wrong?
Two things. The cash anticipated from government, on the face of it, is in line with their promise... pick it apart and it is worth, in 'real-new-money', about half the headline figure. Treasury legerdemain.
The second; in the 100 or so weeks since the Plan's publication... the collapse of social care. Growth in demand from the frail elderly is in line with forecasts. Having them marooned in hospital, waiting to get home wasn't.
No one predicted the speed with which social services would, effectively, go broke and implode, nor foresee the stream of care providers closing down.
Neither predicted was the growth in demand from 25-45 year olds; eschewing primary care for the much more accessible, quicker and more convenient A&E.
Any time, effort or ounce of energy spent grumbling about the money is now wasted. The government doesn't give a tinker's cuss; they are like the three monkeys;
- May hears no problems,
- Hammond sees no problems and
- The Tinkerman doesn't talk about the problems...
There is a bonkers idea that we rewrite the 5YFV! For heaven's sake! Can you imagine the palaver and the brouhaha.
Anyway, as I keep reminding everyone, it isn't a five year forward view any more: it's a 200 weeks forward view.
Reshaping the services within the financial and workforce constraints, dealing with the fact that our closest partners-in-care are skint, is for the STPs.
STPs are the blank sheet of paper on which the future of the NHS will be designed and written. You can help to write part of that future at the STP Summit - details here.
I doubt the picture will be Goya. More likely Jackson Pollock. I doubt the narrative will be Jayne Austin, more likely Ian Rankin. It will be sleeves rolled-up, tactical, doable, painful and sweaty. It will ask awkward questions... we may not know the answers.
It's going to be tricky and if you can't say something helpful; don't say anything. There is a job of work to be done that is not for the squeamish. Neither for the intellectuals in their salons, designed for everything but real work. Nor the lobbyists, in their echo chambers.
We must put our trust in the common sense of common men and women, like us, with no malice... whose only a common purpose, is to go forward on the great challenge of finding solutions to the practical reality of economics and politics that blights our NHS.
If you can't be helpful, creative, innovative, useful... clear off.
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