It probably is

When The Tinkerman fronts-up to the cameras and says 'sorry' for the state of play in the NHS... bet your life he didn't decide to do it off his own bat.

The special advisors, the policy wonks, the media people, the Cabinet and Number Ten would have schemed it.  Fessing up is very unusual very significant.

He is my 18th secretary of state and I have never seen it before.

When the Prime Minister follows-in and does the same, you know they've got the wind-up.  Despite being very grown up, such is politics that it will come back and bite them at the next election and for the rest of their political careers.

Why do it?  

Blanket elective and OP cancellations wasn't part of the plan.  The 111 service is in melt down, ambulance service in shock, primary care besieged, social care... thunderstruck.

There's nowhere to go.  Its a 24crt-gold, copper-bottom mess... on their watch.

Normally, they'd have sacked somebody.   Always a good idea in a crisis.  Who?  They can't sack Simon Stevens.  NHSE is an arms length body.  Only the NHSE board can sack him and they won't... unless the Maymite finds some cahones and fires the chair, Malcom Grant.

They can't sack Dido, she's one of the family, married to a Tory MP and taking the Conservative Whip in the HoL.  Her new Chief Exec is yet to be given the key to the executive loo.

Very likely, the Maymite will be shuffling the pack this weekend.  She could sack the Tinkerman and give Anne Milton a baggage-free clear run?  She'll fare no better.

Like the Xmas Turkey... they're stuffed.  If only they's listen to the siren calls...

If you think they have to apologise now, wait 'till you see what's next.  The flu will crescendo at the end of January and February. 

As serious as the flu can be for yer-granny, significant numbers of NHS staff, picking up the flu from yer-granny and conking-out is a whole new ball-game.  Suddenly the shebang grinds to a halt.  

I hope the SPADs and Trust bosses have figured that out for themselves.  Right now, looking after staff is the number one priority.

The NHS is probably running at about 95% occupancy.  Well above the safe level of around 80%. There are 100,000 beds, when they are full they are full.  There is no spare capacity and no chance to flex.  The NHS works on the edge.

Roughly 40% of beds are used for electives.  Cancel those and you might free-up some head-room.  Not for long, most are in use.

Usually, elective cancellations are done on arrival or the day before admission.  Brutal.  Now electives have been blanket-cancelled, to give patients and the NHS a chance to get organised.

It's not great but it's a bit more humane than messing up the plans of relatives who have taken time off to help, employers who don't know where they are and screwed-up post-op, holiday plans.

To say nothing of each cancellation being a personal calamity.

Let's talk beds... 

In the last 30 years the number of beds have halved, the number of admissions doubled and bed stays slashed by a half.  The UK has 2.6 beds per 1,000 people.  In Germany it's over 8 and 6.1 in France.  Bonkers STPs are planning to close more.

There are 40,000 nurse vacancies.  Under normal circumstances reaching the nominal 1:8 'safe staffing' level is hard enough.  What is happening now is just dangerous.

Trusts are the meat in an indigestible sandwich.  Primary care is supposed to keep people out of hospital.  They can't.  Social care is supposed to get people home and keep them there.  They can't.

Fix it?  You can't.  Not immediately.  

Recruitment;  three years to train a nurse.  Brexit continues to undermine efforts.  

Funding; short term, social care has to be put on the cash equivalent of TPN and primary care, on steroids.  

Find the political will; address taxation, aiming to get back to pre-2010 EU average levels of health care funding.  A grown up conversation with the electorate.

Greater efficiency;  Management costs one pound in a hundred.  Lord Cater says he'll save £5bn but you don't see much of him and I can't hear the money rattling in the tin.

Modernisation; reorganise, charging and all the rest; a distraction.  Forget it. 

Right now, we have to tough it out but as fast as possible; there is an overwhelming need to stop thinking primary care, secondary care and social care and start thinking care.

An integrated health system, capitated, population-based funding, health needs focussed... accountable, caring and organised.

If it looks like an ACO, sounds like an ACO and talks the language of an ACO... it probably is.

Have a good weekend and treat yerself to a flu jab!

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