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News and Comment from Roy Lilley.

How often do you hear or read; 'The NHS has to change'.

Isn't it irritating... the people who say it have no idea how.  The sub-text; as long as you change they don't have to!

We've the world's most admired health system; young or old, rich or poor, drug addict or granny, we'll scoop you up, fix you up and get you up on your feet again; no charge, no judgements, no problem.

What's to change?  If you ask me, nothing.  

However, 7 years of austerity has pretty much decimated public services.  I doubt the economy will be strong enough to fix it in my lifetime.

In the meantime there are some things we could fix.  Ten things, with very little money that might make a huge difference... 

  1.  Switch NHS funding into National Insurance.

The NI is roughly the same spend as the NHS.  The advantage; the public would be able to see, up or down, health spend.  Effectively hypothecated... beyond the reach of the Treasury.  And, if politicians want to play with taxes, it wouldn't include health.

  1.  Reset Agenda for Change.

AfC has played its part but now, too inflexible to allow targeting pay increments to help with hard to recruit hot-spots.  It is not possible to target, say, Band 5 and 6, or MH staff in a particular geography, without making a similar, unaffordable award across the whole pay-spine. 

Yes, the whole NHS deserves a pay rise but with limited funds should we do more to target?

  1.  Recalibrate the GP contract, to encourage services, that are viable for practices and meaningful for patients.

To accommodate one-size-fits-all, the GP contract has grown, like a coral reef.  The Babylon shockwave has highlighted just how difficult it is to make services convenient for people with busy lifestyles, practices to stay solvent and a differential offering for elderly or LTC patients.  The contract concentrates on bricks, in world dominated by clicks.  

We must, urgently, segment patient demand and tailor the response.  In the same way shopping is moving on-line, patient demand will drive primary care services the same way and more out of business.

  1.  Simplify using data.

Today's quantity of health-related data is expected to double every 73 days by 2020.  

The NHS is in the dark ages; data guidance, Data Protection Act, Caldicott reports... make data sharing a minefield.  A disincentive to innovate.  

Simplify opting-out,  otherwise assume data may be used for the purpose for which it is collected; our health and social-care well-being.  It can't be that difficult.  What do other countries do?

  1.  Include foundation level prescribing training for all nurse and AHPs.

If junior doctors can be trained, so can nurses, and AHPs.  There is no legitimate argument against training people to work, comprehensively, in their specialty.  

Make a start with a national, foundation curriculum. There are 17 nurse training schools and 17 curricula. 

  1.  End league tables.

The latest example of how to get it wrong; The Tinkerman's 'league table of procurement'.  I don't want to know who buys the cheapest bog rolls.  I want to know where they get them and what are the terms and conditions.  

Benchmarking clubs share best practice.  League tables encourage people to keep quiet about how they do things... so they can stay at the top they'll do deals in confidence.

  1.  Break-up Public Health England.

I saw on the Beeb, we are the most overweight nation in Europe.  PHE are weight-watching.  Hand the job to a PR company who understand what makes people take notice; give them specific groups to connect with.

  1.  Merge NHSI and NHSE.

In the name of economy and integration.  Jim and Ed have gone from NHSI, no one will trust DiDo and no one any good wants to run NHSI. Seize the moment.

  1.  Cease reliance on inspection to improve quality.

Use data sharing, best practice and embed quality champions into all organisations.  If inspection was going to work, it would have by now.

  1.  Restructure elder care.

There are +800k people with dementia... it will probably be 1m by tea-time.  We don't understand it and there's no sign of a cure.  

Merging health and adult care, tax-beaks and savings bonds for savers and carers.  This is urgent.  As is only registering care homes that have 24hr nurse-prescribing cover.

My ten ideas, taken together,  largely cost neutral.  

What are your's?

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roy.lilley@nhsmanagers.net 

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

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