I've got the feeling that this year is not going to end with either a whimper, or a bang. It's going to fizzle out...
Unless you've had a family wedding, a baby, a new job or the holiday of a lifetime, this might well be the sort of year, that if it were a colour, would be grey.
I know... you'll flick though the pictures on your phone and there will be memories and high spots but as years come, if it were a texture, I guess it would be 40-grit sandpaper.
If years were noises; the spin-cycle on the washing machine.
This has been a year to struggle through and my guess; it's far from over. It's obvious, the NHS can't carry on the way it is and unless they make some quick moves, adult social care will become a relic. And, everything in the shadow of Brexit,
Just as we leave the year, the one move that might drag us out of the mire has, somehow or other turned into a war.
Accountable Care Organisations. They are not complicated. I used to run an accountable care organisation. No, nowhere exotic, like the US. In Surrey. They were called Health Authorities.
We were responsible for the whole health economy. A population based, capitated budget. The idea; get services synchronised. We failed. Not for the want of trying, or brain-power.
We failed because it was in the days before Excel spreadsheets and mobile phones and all the other paraphernalia we take for granted and makes management easier.
We couldn't get a good enough grip on what was happening. Never close enough. Always several steps behind.
Now, we have the technology and no excuses. We can look at the data, see what's happening and where. Do real-time accounting, measure demand, adjust flows and drive a level of efficiency that was impossible as recently as the late 80's.
Lansley's reforms have been a disaster. Under any normal circumstances new legislation would have swept them aside. These times are not normal. Unpicking the 2012 Act would absorb too much Parliamentary focus, when the nation's future depends on a full-on Brexit-fix-it.
As we stand in the wreckage of the NHS, the whiff of cordite still in the air, it's obvious we can't carry on with Lansley's la la. CCGs, squabbling, struggling, merging, federating, muddling through. STPs arrogant, distant, disconnected. Everywhere you look; reconfiguring, devo-ing, merging, not merging... NHSI and E and the DH and useless regulators... it's chaos.
If a visiting Martian said; 'Take me to your leader...' where would you go?
Our healthcare is dependent on a precarious high-wire, juggling act. Cobbled-together solutions, make-do-n-mend.
Accountable care organisation, horizontal alignment of services, population based, capitated budgets. One-pot. One logic; there's no point in the Trusts sucking-in the cash if it means they can't get people home safely, or stem demand without going up-stream.
A realisation the NHS is a whole system.
I know ACOs work because I know why they failed as HAs. We're cleverer now. Better equipped. We know more, understand more. We are wiser. ACOs are designed to end the purchaser provider palaver, contracting, cut costs and syndicate resources.
Are they the harbinger of privatisation?
Look at the evidence; the likes of Virgin, Circle, Serco, hospital transport providers, care home operators, App makers, cleaning companies have either lost their shirt, vest and pants or are in the process of... even genuine suppliers can't get paid on time.
There's no money in healthcare. Forget it.
Yup, there is no legal basis for ACOs and no Parliamentary time to create it. So what? Does that worry the majority of the public who simply want the Five Gets;
Get in, Get diagnosed, Get fixed-up, Get out and Get on with their lives.
They just want us to Get-a grip with sorting-out the disjointed mess. Select committee navel gazing just takes up time and effort.
I've talked a lot about the tough time at the front-line of health care. It's tough for managers, too. What we've got doesn't work and is descending into chaos. No plan, no direction, no shape? Managers need new levers and new systems. Tools to create and make with, not weapons to defend and fight with.
No one comes to work to close stuff but we are. Lots of it. Next year we will have to come to work with an open-mind.
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