Tuesday, November 24, 2015

Game's afoot

Ring out the bells. Splay the festoons. The NHS has got  4 billion pounds..extra. Well, actually, not quite but let's not worry too much about details. The point is the promised extra money has indeed been front loaded..and cut it any way you want, it's there. Simon Stevens laid out his stall, flexed his muscles and got what he wanted. So in simple language what does it actually mean?

Well for starters, it's definitely welcome. Look at other areas and you have to take a deep breath...cuts galore ..so in that context, rejoice indeed. Now the fun begins though...for starters Stevens authored the 5 year forward view, asked for 8 billion and promised a 22 billion efficiency. He got the 8 billion. Then he wanted it front loaded, he's got it too...Now? It's all down to him...reputation on the line...put all his political capital on the line...high stakes indeed.

The problem? That pesky efficiency drive...hugely dependant on 2 things...pay restraint and new models of working. That pay restraint thing is nit going so well..(have you heard that thing about junior doctors) and the Consultants, for once, are starting to stir. Then you look at the GPs...and heck they are pretty pissed off too.
Those new models of care? Well Sam Jones is in charge of that..and good new concepts too- the problem? Can these go to scale? Will a disgruntled workforce play ball? How DO you get a workforce facing pay restraints/cuts to play ball...tricksy tricky.

To put some maths into it. We should have made about 4 billion efficiency savings by end March 2016...if you follow the 22 billion efficiency savings by 2020 mantra. Well, we are 1.6 billion over spent already...the new boss of NHS improvement suggests we will keep it at that by end March 2016. With winter yet to come, gaps galore in rota...one would like to see a feat even Houdini would be proud of.

So 4 billion buys you breathing space..buys you some time in a gasping environment...a bit like a pocket of oxygen a drowning man finds. The question is what next? A massive. Bit hinges on new ways of working...and with the greatest amount of respect to all our leaders, if you haven't achieved that in times of plenty, how do you do so in times of scarcity? Game on folks...it's time to test those leadership skills...history will be the judge for sure.

Finally, that little bit of Public Health and Health education coming outside the ring fence. As a Diabetologist, you can only wince...let's pay more for swanky coronary care units but not to prevent type 2 diabetes which causes the coronary events? Well then...that will be interesting indeed.

So...4 billion...yes- a massive win for Stevens, a breathing space for the NHS...the rest of the efficiency...I am not going to be negative and say no way...but it is going to be very very tricky. I, as part of NHS Survival, have always advocated an independent NHS funding review. I also accept thre have been instances of so- such as Wanless or Barker...problem being there has been no pr-agreement from all parties to accept the recommendations. By 2017/2018..the chorus for that will become louder..and it could indeed suit the government to ask for one in 2019. The question is whether by that time, quality of services would have dipped down too far..or not.

The game indeed is afoot.  A lot of national leaders will earn their corn or move on to other pasties. If they do achieve the impossible, then the nation as a whole, will indeed owe them a big thank you and perhaps also ensure Stevens is remembered as the genuine Messiah.  We shall see.

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