Saturday, April 11, 2015

The efficiency cocktail

I am not easily impressed but I must say I am now. Simon Stevens, the NHS boss has indeed achieved something few have. I have liked the 5 year forward view thoughts from a clinical perspective - as if you see it from the prism of my specialty, it lends itself well plus has looked like a genuine roll of the dice to see if integration can be done by changing the structures...not to mention it was a nifty bypass of the Lansley act. So clinically I was interested and then having seen Samantha Jones take up the helm in guiding the Vanguards and a brief chat later, yep, clinically I certainly see it having legs...if..and that is a big if...if there is genuine appetite amongst all the stakeholders to commit to the process.

However I have been more impressed as to how with elections looming, the "give us 8 billion" has become something all are either being forced to commit to...or having to find ways of doing so. It's amazing as before the 5YFV, no one actually knew what was needed, apart from "give me more"... And then suddenly we had a figure. Hidden beneath that is the rest 22 billion needed in efficiency which I will come to later..but at least, we are starting to get finite numbers promised by politicians towards the NHS..a different debate whether it will be delivered,how etc

The obvious flip to that is if that 8 billion does arrive, does the onus for delivering the rest 22 billion fall on the NHS? We ( and I know many will claim Stevens doesn't speak for them..but as with any organisation, the man is our CEO and that document was probably one of the most lithe and sensible ones I have read in a long time) asked for a certain sum of money and said we would find the rest in efficiency. Would the politicians be emboldened enough to say "ok then..here's your 8..now if you can't find 22...sorry..your fault, not mine"? Fascinating in its own right but I must applaud the fact that Stevens has at least managed to get the politicians to commit to something finite..it's a start compared to "just give us more"

Then comes the 22 billion...some believe it's possible, a lot believe it's easier to actually discover life on Mars. We shall see..I have my doubts as anyone else..for starters, if I was a hospital trust finance director I would be pretty worried. Better get cracking quickly to be a PACS..or its gonna be time to poach others work. In the mix is 7 day services...oh such a heady cocktail...factor in shrinking tariff and you can see where the efficiency drive will be aimed. To complicate things, comes the signs of provider revolt..already due to have a bearing on repeat admission tariffs..what a sumptuous cocktail we indeed have!
Did anyone say we should have less managers? Well, it's probably time to stop churning that nice sound byte. We need some good managers..and never more if we are to get anywhere near those efficiency numbers. Not to mention the fact that even if you take away all those nasty managers, it will still give us a decimal fraction of the 22 billion

And let's also see what comprised a significant chunk of efficient savings last time..ah yes..pay freezes...more to come? Consultant contract negotiations...now there's another battle ground..thought to be fair that's probably aimed at the 7 day services and see whether it can be delivered without a huge rise in cost. Isn't that cocktail tasting marvellous? GPs according to a survey have said they don't want 7 day services with all other pressures, we keep looking for Narnia for those GPs sitting around...the pressure cooker is building.

So there we have it. 8 billion asked..and looks like we may get it...and if we do, then we won't necessarily be in a position to blame politicians...but that's only part of the picture with the bigger challenge of 20 billion to get.
We have pinned a lot of faith on the new models in 5YFV and fingers crossed, some of them come up. Not many have faith that the efficiency money asked for will happen...and indeed there are some who believe that the NHS is so big that money will come, from somewhere as "it always does". We shall see but it would be foolhardy to say this could be a helluva ride for quite a few of us. My view? Yes it's theoretically possible to get close to that but it needs massive changes on huge scale, changing mind sets etc but when I see how little we have achieved with 7 day service or integration due to conflicting interests etc, the reality worries me. A lot.

Do I envy any manager, clinical or otherwise, under pressure to deliver efficiency....Nope...but I will sit and sip on a cocktail and wish them all,the very best. From the bottom of my heart.    

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