A big thing to somebody…

News and Comment from Roy Lilley.

Did you see the letter from 90 MPs encouraging the Chancellor to come up with a bung in the budget?

The DH press office said:

'The government had already provided an additional £2bn to social care over the next three years...'  

...three years; say150 local authorities.  I make that just about £12k a day, each.  Ho, hum...

Why're the MPs writing?  

Maybe they know something and want to take the credit.  

Or, they're knee-deep in correspondence with constituents; complaining about waiting times, poor care for granny and are covering their backsides.  

'... I wrote to the Chancellor... highlighting the situation... but the economy blah, blah...'

A Change-Week, on the road with the Academy, 30 visits in 5 days, tells you something about the state of care.  Gives a feel for what some solutions might be.

There are four.  Excluding the Chancellor coz; spending at this late stage, without ricochetting inflation through the system, is tricky.

First... the bow-wave of debt that is drowning three-quarters of Trusts.  

The dilemma; 

...do Trusts deliver care if they can but focus on balancing the books, 

or; 

...do Trusts focus on care and deliver a balance, if they can.  

Saying 'do both' shouts; you just don't get the situation. 

Trust debt is structural.  New money coming into the system will be syphoned into delivering a balance because it's the Regulator's job to cajole, bully and be a damned nuisance. Idiotic STPs closing beds is also about achieving balance, not improving services.

If we think looking after patients in a safe and timely fashion is what the NHS is for, we should do what businesses, facing a financial problem, do... they restructure debts... turn them into shares.  In our case the Treasury would convert debt into Trust's public dividend capital.

PDC is usually repaid by way of dividends to the DH.  The DH can postpone payments and the Treasury could refinance debts with a bond issue, or even quantitive easing. 

Yup, unorthodox but the reason Trusts have to chose between cash-for-care or cash-for-balance is that they have been providing more care than they've been paid for, trying to keep up with the absurd demands of Regulators, targets, waiting times and the like.

By the way; this winter's demand plans have

already been described as 'LaLa Land and 'barking mad'.  The new winter Tzar Pauline Philip seems to have lost the plot, lost the emergency room and lost the confidence of the CEO's she depends on, already... it's only November!

Trusts must have a balance sheet moratorium.

Second; care homes.  

I think demand via care homes is a mostly avoidable, self inflicted disgrace.

The CQC have to rethink care-home-regulation.  No care home should be licensed without 24-7 cover from a care-of-the-elderly, prescribing nurse specialist.

Care home admissions for falls and UTIs is little more than neglect and costs bed-days... creating discharge mayhem.  A quick fix is for CCGs to pay for community matrons to target care homes.  Whatever that costs is cheaper than a fortnight in hospital.

An admission from a care home should be regarded as a serious untoward incident.  

The inability to discharge a resident, safely, back to their care home, for want of an externally provided care package, regarded as neglect, the care home fined.

Three; practices and GPs have to step up.  

Some are terrific.  The time I spent at the Oxford Terrace and Rawling practice in Gateshead was an eyeopener.  Sadly, the numbers tell us this sort of excellence is all too rare.  It's obvious, some practices don't put themselves out and pitiful few CCGs bring innovation, analysis and money to the predicament.

Innovation; try Bath, Falls Rapid Response.  SW Ambulance paramedics, physio's, OT's, RUBHFT and Virgin Care changing the lives of frail people.  Their trial outcomes are astounding.  Multiplied across the NHS...  would be breath-taking.

Finally, without a medical reason, no one working in the NHS should be allowed to work without a flu-jab.  End-of.  

Hours of time and goodness knows how much money is wasted on 'persuading' staff to do what, common-sense tells you, should be mandatory.

In five days I learned a lot more than four things but mainly I learned; there is no such thing as a small thing.  

A small thing is a big thing to somebody!

Thank you to everyone who hosted the teams and don't forget to share your outcomes.  Show us all what good looks like!

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roy.lilley@nhsmanagers.net 

Know something I don't - email me in confidence.

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