Creating it now


News and Comment from Roy Lilley.

If I had a pound for every time someone asked what’s going to happen to the NHS… I’d have enough to buy the Penderyn factory and then; ‘Frankly, my dear, I wouldn’t give a dam!’

But I don’t and I do and so do you.

Predicting the future?  Mug’s Game.  Peter Drucker spoke of being able to identify major events that have happened, that will have predictable effects on what will happen.

Drucker says the big issue is demographics;

‘The key factor for business will not be the overpopulation of the world… it will be the increasing underpopulation of the developed countries.’

He said, the developed world is in the process of ‘committing collective suicide’. 

We’re not making enough babies… as a result, younger, working people are no longer able to bear the increasing burden of supporting a growing population of older nonworking people.

Drucker says we can offset this rising burden by cutting back at the other end of the dependence spectrum, which means having fewer or no children.  Population in Italy, Japan and the US, is dropping.  We know what’s happening here, in consequence; retirement ages are being realigned.

The upshot; the future cannot be about putting more people to work for longer.

Drucker said, the future…

‘… can come only from a very sharp and continuing increase in the productivity of the one resource in which developed countries still have a competitive edge; knowledge work and knowledge workers.’

Products will come from countries where labour is cheap and plentiful and they are not European. 

If this all sounds a bit Davos and fancy-pants, it’s because it is.  You have to think and think hard.

Writing about thoughts gives them clothes. Makes them visible.  Drucker is right, our future has already happened and it’s threadbare.  It’s too late to change it.  That’s what I want you to see.

Relentless pressures on the NHS have already shaped its future.  So, we know what’ll happen.

Setting aside vocation, which cannot be relied on because you can’t buy it, recruitment will become even harder.  The signs are there; workforce bolstered by overseas recruitment, now cut off and an ageing population.  Vacancies in the thousands.  Go figure.  

We’re extending working years, exactly as Drucker predicts.

Expecting services to meet the demands of an ageing population, with an ageing workforce employed, longer, in an exhausting and unpopular sector is, well… stupid.

There’s more…

No matter how much the Dad’s Army thinkers parade their demands for more money; there isn’t going to be any.  There might be a bung here and a few quid there but it’s not money, money.

This government can’t pay, won’t pay and won’t ask us to pay because it is an electoral risk.

Pressures have wreaked unseen damage.  Operational costs; overtime, agency, consumables, overheads and utilities have been phenomenal.  Trusts already have a bow-wave of debt, accumulate that with the enhanced costs of running through to March 31st and most balance sheets will be beyond repair.

NHSI board will be tested.  My guess, they can’t handle this.  The DH will try to insist on delivering the Departmental Expenditure Limit… it’s not possible.  

The only way out; the Treasury subsumes the over-runs in ‘shares’, public dividend capital.  A debt for equity swap.

Not to do so will condemn Trusts to years of cheese-pairing cuts, to catch up with debt.  We will end up with a poor service for poor people.

Trusts are underfunded for their activity.  They should be treated as heroes, not debtors.  

After that, the costs of a Board, for every Trust, becomes a luxury.  Semi-autonomous Trusts… not for much longer.  Think centralisation, local leaders and crowd sourced opinions. 

Something else…

If retailers are shrinking because of pressures from on-line shopping and overhead costs, exacerbated by avaricious local authorities hiking charges to pay for public services, so will primary care.  

Primary care is corner shop, healthcare retailing and will go the same way as Blacks Leisure, BHS, Jaeger and Woolworths.

GPs are inadequately funded, can’t cope with the demand from people with longterm conditions, appointments are full. Unable to keep frail people out of hospital, ambulances are full.  GPs will end up on the hospital campus and the working sick on the end of a FaceTime call. 

We have the data and the technologies to halve GP appointments and reduce outpatient visits by two thirds.  The GP contract, is all about bricks and mortar, it will give way to clicks and the nimble, knowledge-worker super star that Drucker tells us about.

Drucker is right, the future is obvious, we are creating it, now.


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