The changes we know we need…

News and Comment from Roy Lilley.

Whatever your politics... the facts are; we're stuck in the middle of a political and economic dilemma we've not faced since the last world war.

None of the parties can muster a full team of competent, trustworthy and experienced people who have a cohesive, consolidated, clear view of what to do.

The Budget said it all.  The economy's not growing... it's slipping downhill.  That's all that matters.

Brexit; has already lost jobs.  The sliding pound...  bad news for everyone except those exporting spuds.  We will be poorer for longer than we thought.  We are bottom of the G7 with Portugal.

I know, this isn't what you want for a Monday morning!  Let's turn to the one ray of hope.  Of all the public sector, only the NHS got more money.

That tells me things.

HMG have put the NHS before all the other public services because of the importance the NHS plays in national and family life and are not looking for a row about it.  Now it appears the Chancellor might have created one. I'm not so sure the story is 100% right...

We are where we are and any more time spent shouting about NHS funding, picking at the politics, for the foreseeable, is a futile waste of energy.

The pre-budget pleading from the King's Fund, Nuff's, Health Foundation, Confed, Providers, Employers, unions and the rest, was a waste of time.  There never was going to be £4bn.  The economy's not delivering and the Brexit reserve comes first... to say nothing of saving up for the final bill.

All this lot have to get real... or we'll stop listening to them.

The latest NHS cognoscenti fad; 'what shall we stop doing...'

My answer; nothing.  We should carry on delivering whatever it takes to provide the care that is needed, in the places it is wanted, by the people who can do it, in a timeframe they can manage.

If it busts budgets, so be it.  If it busts targets, change the targets.  The Departmental Expenditure Limit?  That's the Department's problem, not the docs and nurses on Ward D.

Most EU countries, post banking crisis, continued to fund their health systems by about 4% a year.  HMG has let ours, practically, flatline. You get what you pay for.  Deliver the problem right back to Number 10 and shove it through their letter box. 

If NHSI get difficult, tell them 'naff-off.  I'm sick of the stories reaching me, about their bullying, doing the politicians dirty work. Real people are more important than the regulator's spread-sheet.  

Give Dido and her new side-kick (if they can find anyone to do it) the most difficult job in the galaxy.  Make sure she runs back to her Tory friends and tells them.

For sure we have to get smarter, more open-minded, less defensive, territorial... and, we have to march forward, in-step, to the meter and measure of innovation and transformation... 

... but the unions, the Royal Colleges and all the rest have to step up.

If we stop doing anything, we should stop pretending. 

Stop pretending there was a golden age of healthcare... there never was.  It was always difficult. 

Stop pretending we can do things when we can't.  Say so and tell the pubic why.  We are protected by a duty of candour.  Make it work for you.

Stop pretending inspection works.  There's talk of a plan for the CQC to charge Trusts a £m for an inspection... nuff said.

Stop pretending we can modernise primary care without changing the GP contract.  It focusses on buildings.  Find ways of taking primary care to where the people are.  Right now we don't even know how many people visit their GP every day, or what for.

Stop pretending there's going to be a public debate over the future of the NHS.  There's no mechanism.

Stop pretending we will ever do anything clever with IT and data until we can scrape Caldecott off our boots, stamp-out the fear of the Data Protection police and kick some common-sense into the use and sharing of data.

Stop pretending the duplication of NHSI, E and DH is a good use of public money.  Engineer them back to operational togetherness.  No laws required.

Stop pretending NHS productivity is poor.  It's 1.7%.  The economy is poor, 0.2%.

Stop pretending the service can cope with more targets, league tables, initiatives and palaver.  What we are doing is good enough, to be good-enough, for the time being.

Stop pretending the future is adult social care and the NHS in separate organisations.

Stop pretending ignoring social care in the budget was anything more than stupidity.

Stop pretending waiting for the upshot of a Green Paper on funding social care will take anything less than two years and is anything more than kicking the problem into the long grass.

Stop pretending the next big thing is coming to sort it out - it's not.  What's needed is beyond the DH, the government.  They can't make a difference.  It's up to you, us, everyone.  

It's easy to be critical, cynical about making a difference.  Remember, you are who you hang-out with. 

We can all do small things that add up to making a difference and together they will help making the changes we know we need.

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roy.lilley@nhsmanagers.net 

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