Show me yours

primary_care_training_show_me_yours-01

Ok, let's do it...

... the funding thing.  Somebody has to go first...

If we had a pound for every column-inch that's been written about the NHS being short of money... we'd be rich.  

Everyone says how difficult it is, how much of a challenge.  There is speculation, think-tankery and Tom Foolery.  

No one says how to fix it.  

The Dad's Army brigade who charge Trusts a fortune to represent them, the lap-top-policy-kids, the glossy think-tanks with their shiny offices, the consul£ancies, the columnists and journo's... wringing their hands.  Nothing from political parties - heaven forfend... 

In the spirit of; 

'We have to stop dancing around our handbags and somebody has to go first'

... I'll go first.

High level analysis...

  1. The Tories have made a mess of funding and organising the NHS.  They know it but dare not admit it... so don't try and make them.
  2. Brexit is a catastrophe but if we are smart, creates a fulcrum point.
  3. There's no money unless we get the taxpayer to stump up.
  4. The public love the NHS and hate politicians.
  5. The NHS is very efficient but people don't believe it.

Any funding deal has to be a formula that takes into account these five, key issues.  

In plain English; 

'... we have to save face for the Tories, reflect the 'success' of Brexit, show the tax-payer the NHS is worth an extra quid if used exclusively for health and be seen to make an effort ourselves.'

Here's how I see it... it's not elegant but doable;

A political commitment to return NHS funding to the 4% pa annual uplift we had between 1948 and 2010.  We know that figure sort-of works.  

The 4% uplift composed; 3% cash and 1% NHS internally generated savings, each year, until we leave the EU.  

Thereafter, the Boris-Bus-Bonus-Bung is available (£350m a week, not sent to the EU, means we'd have about £8bn to spend here), hold the Brexit Brigade to their braggadocio...  so, on parting company the NHS efficiency contribution drops to 0.5%.

Uplifts to include NHS generated savings?  Yes, it worked in the 80's and 90's... why not now?  Shows we are doing our bit.

Take the pressure off the Treasury.  Ask the taxpayer to help get the NHS back on its feet, in its 70th year; 2p on income tax, hypothecated for the NHS, until we leave the EU. (1p equates to £5bn).  My hunch; the public would go for that.

The political narrative is tricky...

We have to avoid; 'The Tories have knackered the NHS and we must bail it out'.  

We have to say; 'Reflecting the success of the NHS in its 70th year and the pressures of demand, help it with a lifeline until we have the Brexit bonus...'

For the future.  A manifesto commitment; an hypothecated health and care funding tax, replacing national insurance.  Details to be developed before the election, so we know what we are voting for.  It's not difficult, some adjustment in taxation and contributions and the job's a good-un.

Make the fund transparent, on line and out of the reach of the Treasury.  No pinching it to fill holes in the roads or buy tanks.  Force the politicians into the 'keeping a promise' corner.  

A cross party, on-going commitment to keep NHS funding in-line with the EU average.  Yup, we won't be in the EU but it's a benchmark to hold the government's feet to the fire.

I don't know

if these percentages or numbers are right and we may well need some new laws to make it happen but in principle... 

I do know

we have to stop moaning and start thinking.  Stop pointing out there is a problem and start trying to point out solutions.

Leadership is about simplifying, cutting through the arguments, debates and doubts.  Coming up with solutions everyone can understand.  

So, there's the challenge to our leaders... pick the bones out of my solution, poke a stick at it, show its imperfections, have a larf.  

I don't care... as long as you show me yours. 

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roy.lilley@nhsmanagers.net 

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.